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/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/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/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, 2022 Last Revised: May 10, 2022 Replaces: ...
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 fully-insured ...
https://www.premera.com/medicalpolicies/10.01.533.pdf#search=policy
MEDICAL POLICY - 10.01.533 Non-covered Experimental/Investigational Services Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
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, 2022 Last Revised: Aug. 8, 2022 ...
https://www.premera.com/medicalpolicies/2.04.136.pdf#search=policy
MEDICAL POLICY - 2.04.136 Nutrient/Nutritional Panel Testing BCBSA Ref. Policy: 2.04.136 Effective Date: Feb. 1, 2023 Last Revised: Jan. 23, 2023 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.616.pdf#search=policy
MEDICAL POLICY - 5.01.616 Pharmacologic Treatment of Gout Effective Date: Dec. 1, 2022 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/8.01.11.pdf#search=policy
MEDICAL POLICY - 8.01.11 Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies BCBSA Ref. Policy: 8.01.11 Effective Date: Oct. 1, 2022 ...
https://www.premera.com/medicalpolicies/2.04.123.pdf#search=policy
MEDICAL POLICY - 2.04.123 Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue Diseases BCBSA Ref. Policy: 2.04.123 Effective Date: Aug. 1, ...
https://www.premera.com/medicalpolicies/2.04.514.pdf#search=policy
MEDICAL POLICY - 2.04.514 Protein Biomarkers for Diagnosis and Risk Assessment of Prostate Cancer BCBSA Ref. Policy: 2.04.33 Effective Date: Jan. 1, 2023 Last Revised: Dec. 23, ...
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/5.01.575.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.575 Dupixent® (dupilumab) Effective Date: Dec. 1, 2022 ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.588.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.588 Pharmacologic Prevention and Treatment of HIV/AIDS ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/7.01.170.pdf#search=policy
MEDICAL POLICY - 7.01.170 Laser Interstitial Thermal Therapy for Neurological Conditions BCBSA Ref. Policy: 7.01.170 Effective Date: Feb. 1, 2023 Last Revised: Jan. 23, 2023 ...
https://www.premera.com/medicalpolicies/7.01.85.pdf#search=policy
MEDICAL POLICY - 7.01.85 Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures BCBSA Ref. Policy: 7.01.85 Effective Date: July 1, 2022 Last Revised: June ...
https://www.premera.com/medicalpolicies/7.01.92.pdf#search=policy
MEDICAL POLICY - 7.01.92 Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone BCBSA Ref. Policy: 7.01.92 Effective Date: Oct. 1, 2022 Last Revised: Sept. ...
https://www.premera.com/medicalpolicies/9.03.508.pdf#search=policy
MEDICAL POLICY - 9.03.508 Orthoptic Training, Vision Therapy, Visual Perceptual Training, Vision Restoration Therapy, and Neurovisual Rehabilitation BCBSA Ref. Policy: 9.03.03 ...
https://www.premera.com/medicalpolicies/1.01.24.pdf#search=policy
MEDICAL POLICY - 1.01.24 Interferential Current Stimulation BCBSA Ref. Policy: 1.01.24 Effective Date: Sept. 1, 2022 Last Revised: Aug. 8, 2022 Replaces: N/A RELATED MEDICAL ...