https://www.premera.com/medicalpolicies/15.01.026.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.026 Testing for Vector-Borne Infections Ref. Policy: G2158 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/2.02.507.pdf#search=policy
MEDICAL POLICY - 2.02.507 Coronary Angiography for Known or Suspected Coronary Artery ... criteria within this policy DO NOT apply to Indian Health Services (IHS) facilities. ...
https://www.premera.com/medicalpolicies/3.03.523.pdf#search=policy
PHARMACY / MEDICAL POLICY - 3.03.523 Prescription Digital Health Diagnostic Aid for Autism Spectrum Disorder BCBSA Ref. Policy: 3.03.01 Effective Date: May 1, 2026 Last Revised: ...
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, 2025 Last Revised: Oct. 27, 2025 ...
https://www.premera.com/medicalpolicies/5.01.532.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.532 Cutaneous T-Cell Lymphomas (CTCL): Systemic ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
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/7.01.165.pdf#search=policy
MEDICAL POLICY - 7.01.165 Radiofrequency Coblation Tenotomy for Musculoskeletal Conditions BCBSA Ref. Policy: 7.01.165 Effective Date: Mar. 1, 2026 Last Revised: Feb. 9, 2026 ...
https://www.premera.com/medicalpolicies/7.01.599.pdf#search=policy
MEDICAL POLICY - 7.01.599 Total Ankle Arthroplasty in Adults Effective Date: Jun. 1, 2026 ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.604.pdf#search=policy
MEDICAL POLICY - 7.01.604 Gastroesophageal Reflux Surgery in Adults BCBSA Ref. Policy: Not Applicable Effective Date: Sep. 1, 2026 Last Revised: Aug. 10, 2026 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.582.pdf#search=policy
MEDICAL POLICY - 5.01.582 Antibody-Drug Conjugates Effective Date: Sep. 1, 2026 Last ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/5.01.616.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.616 Pharmacologic Treatment of Gout Effective Date: Jun. ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
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/5.01.637.pdf#search=policy
PHARMACY POLICY - 5.01.637 Pharmacologic Treatment of Alopecia Effective Date: Jun. 1, ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/1.01.539.pdf#search=policy
MEDICAL POLICY - 1.01.539 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions BCBSA Ref. Policy: 1.01.15 Effective Date: Nov. 1, 2025 Last ...
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/15.01.016.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.016 Identification of Microorganisms using Nucleic Acid Probes Ref. Policy: M2097 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 ...
https://www.premera.com/medicalpolicies/15.01.036.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.036 Diagnosis of Idiopathic Environmental Intolerance Ref. Policy: G2056 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 Replaces: N/...
https://www.premera.com/medicalpolicies/2.01.106.pdf#search=policy
MEDICAL POLICY - 2.01.106 Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel Syndrome BCBSA Ref. Policy: 2.01.106 Effective Date: Jan. 1, 2026* Last Revised: Dec. ...
https://www.premera.com/medicalpolicies/2.01.100.pdf#search=policy
MEDICAL POLICY - 2.01.100 Dry Needling of Trigger Points for Myofascial Pain BCBSA Ref. Policy: 2.01.100 Effective Date: Jul. 1, 2026 Last Revised: Jun. 8, 2026 Replaces: N/A ...
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, 2025 ...