https://www.premera.com/medicalpolicies/8.01.52.pdf#search=policy
MEDICAL POLICY - 8.01.52 Orthopedic Applications of Stem Cell Therapy (Including Allografts and Bone Substitutes Used with Autologous Bone Marrow) BCBSA Ref. Policy: 8.01.52 ...
https://www.premera.com/medicalpolicies/8.01.532.pdf#search=policy
MEDICAL POLICY - 8.01.532 Hematopoietic Cell Transplantation in the Treatment of Germ-Cell Tumors BCBSA Ref. Policy: 8.01.35 Effective Date: Apr. 1, 2023 Last Revised: Mar. 20, ...
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/1.04.502.pdf#search=policy
MEDICAL POLICY - 1.04.502 Myoelectric Prosthetic and Orthotic Components for the Upper Limb BCBSA Ref. Policy: 1.04.04 Effective Date: June 1, 2023 Last Revised: May 5, 2023 ...
https://www.premera.com/medicalpolicies/2.01.526_2024-04-04.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/2.04.119.pdf#search=policy
MEDICAL POLICY - 2.04.119 Multibiomarker Disease Activity Blood Test for Rheumatoid Arthritis BCBSA Ref. Policy: 2.04.119 Effective Date: Sept. 1, 2023 Last Revised: Aug. 21, 2023 ...
https://www.premera.com/medicalpolicies/2.04.125.pdf#search=policy
MEDICAL POLICY - 2.04.125 Proteomic Testing for Systemic Therapy in Non-Small Cell Lung Cancer BCBSA Ref. Policy: 2.04.125 Effective Date: Feb. 1, 2024 Last Revised: Jan. 8, 2024 ...
https://www.premera.com/medicalpolicies/5.01.569.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.569 Pharmacotherapy of Type I and Type II Diabetes ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/5.01.574.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.574 Pharmacotherapy of Spinal Muscular Atrophy (SMA) ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.640.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.640 Pharmacologic Treatment of Sickle Cell Disease ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/7.01.153.pdf#search=policy
MEDICAL POLICY - 7.01.153 Adipose-Derived Stem Cells in Autologous Fat Grafting to the Breast BCBSA Ref. Policy: 7.01.153 Effective Date: Mar. 1, 2024 Last Revised: Feb. 26, 2024 ...
https://www.premera.com/medicalpolicies/7.01.171.pdf#search=policy
MEDICAL POLICY - 7.01.171 Remote Electrical Neuromodulation for Migraines BCBSA Ref. Policy: 7.01.171 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.539.pdf#search=policy
PHARMACY POLICY - 5.01.539 Pharmacologic Treatment of Cystic Fibrosis with Ivacaftor ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
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/5.01.549.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.549 Off-Label Use of Drugs and Biologic Agents Effective ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/1.01.537.pdf#search=policy
MEDICAL POLICY - 1.01.537 Low Intensity Pulsed Ultrasound Fracture Healing Device BCBSA Ref. Policy: 1.01.05 Effective Date: June 1, 2023 Last Revised: May 5, 2023 Replaces: ...
https://www.premera.com/medicalpolicies/2.04.520_2024-04-04.pdf#search=policy
MEDICAL POLICY - 2.04.520 Laboratory Testing Investigational Services BCBSA Ref. Policy: 2.04.159 Effective Date: Apr. 4, 2024* Last Revised: Dec. 11, 2023 Replaces: N/A *View the ...
https://www.premera.com/medicalpolicies/4.02.06.pdf#search=policy
MEDICAL POLICY - 4.02.06 Uterus Transplantation for Absolute Uterine Factor Infertility BCBSA Ref. Policy: 4.02.06 Effective Date: Nov. 1, 2023 Last Revised: Oct. 9, 2023 ...
https://www.premera.com/medicalpolicies/5.01.575.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.575 Dupixent (dupilumab) Effective Date: Dec. 1, 2023 ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.638.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.638 Omisirge (Omidubicel) Effective Date: Sept. 1, 2023 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...