https://www.premera.com/medicalpolicies/5.01.616.pdf#search=policy
MEDICAL POLICY - 5.01.616 Pharmacologic Treatment of Gout Effective Date: Mar. 1, 2024 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.623.pdf#search=policy
PHARMACY POLICY - 5.01.623 Topical Drugs for Actinic Keratosis and Other Dermatologic ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.628.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.628 Pharmacologic Treatment of Atopic Dermatitis ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/8.01.15.pdf#search=policy
MEDICAL POLICY - 8.01.15 Hematopoietic Cell Transplantation for Chronic Lymphocytic Leukemia and Small Lymphocytic Lymphoma BCBSA Ref. Policy: 8.01.15 Effective Date: April 1, 2024 ...
https://www.premera.com/medicalpolicies/8.01.66.pdf#search=policy
MEDICAL POLICY - 8.01.66 Chimeric Antigen Receptor Therapy for Multiple Myeloma BCBSA Ref. Policy: 8.01.66 Effective Date: April 1, 2024 Last Revised: Mar. 25, 2024 Replaces: N/A ...
https://www.premera.com/medicalpolicies/1.01.530.pdf#search=policy
MEDICAL POLICY - 1.01.530 Children's Therapeutic Positioning Equipment Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/1.01.540.pdf#search=policy
MEDICAL POLICY - 1.01.540 Continuous Passive Motion in the Home Setting BCBSA Ref. Policy: 1.01.10 Effective Date: June 1, 2023 Last Revised: May 9, 2023 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/10.01.532.pdf#search=policy
MEDICAL POLICY - 10.01.532 ASAM Criteria: Services Reviewed for Medical Necessity ... N/A RELATED MEDICAL POLICIES: None This policy only applies to Washington Individual ...
https://www.premera.com/medicalpolicies/2.01.526.pdf#search=policy
MEDICAL POLICY - 2.01.526 Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders BCBSA Ref. Policy: 2.01.50 Effective Date: April ...
https://www.premera.com/medicalpolicies/2.01.91.pdf#search=policy
MEDICAL POLICY - 2.01.91 Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia and Gastroparesis BCBSA Ref. Policy: 2.01.91 Effective Date: Feb. 1, 2024 Last Revised: ...
https://www.premera.com/medicalpolicies/2.02.507.pdf#search=policy
MEDICAL POLICY - 2.02.507 Coronary Angiography for Known or Suspected Coronary Artery ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/2.02.26.pdf#search=policy
MEDICAL POLICY - 2.02.26 Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation BCBSA Ref. Policy: 2.02.26 Effective Date: Aug. 1, 2023 ...
https://www.premera.com/medicalpolicies/2.04.513.pdf#search=policy
MEDICAL POLICY - 2.04.513 Drug Testing in Pain Management and Substance Use Disorder Treatment Settings BCBSA Ref. Policy: 2.04.98 Effective Date: Feb. 1, 2024 Last Revised: Jan. ...
https://www.premera.com/medicalpolicies/5.01.547.pdf#search=policy
PHARMACY POLICY - 5.01.547 Medical Necessity Criteria and Dispensing Quantity Limits for ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.548.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.548 Pharmacotherapy of Cushing's Disease and Acromegaly ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.578.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.578 Amyotrophic Lateral Sclerosis (ALS) Medications ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.593.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.593 Pharmacologic Treatment of Transthyretin-Mediated Amyloidosis BCBSA Ref. Policy: 5.01.30 Effective Date: Mar. 1, 2024 Last Revised: Feb. 13, ...
https://www.premera.com/medicalpolicies/5.01.608.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.608 Pharmacologic Treatment of Postpartum Depression ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.611.pdf#search=policy
PHARMACY POLICY - 5.01.611 Pharmacologic Treatment of Urea Cycle Disorders Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.618.pdf#search=policy
PHARMACY POLICY - 5.01.618 Selective Estrogen Receptor Modulators and Down Regulators ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...