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/2.01.106.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: Nov. 1, 2024 Last Revised: Oct. ...
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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: Jun. ...
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, 2025 Last Revised: ...
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: August 1, 2024 ...
https://www.premera.com/medicalpolicies/2.04.152.pdf#search=policy
MEDICAL POLICY - 2.04.152 Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes BCBSA Ref. Policy: 2.04.152 Effective Date: May 1, 2025 Last Revised: Apr. 7, 2025 ...
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, 2025 Last Revised: Jan. ...
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 ...
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PHARMACY / MEDICAL POLICY - 5.01.569 Pharmacotherapy of Type 1 and Type 2 Diabetes ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
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PHARMACY POLICY - 5.01.611 Pharmacologic Treatment of Urea Cycle Disorders Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
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PHARMACY POLICY - 5.01.636 Chronic Hepatitis B Antiviral Therapy Effective Date: Mar. 1, ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
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PHARMACY / MEDICAL POLICY - 5.01.640 Pharmacologic Treatment of Sickle Cell Disease BCBSA Ref. Policy: 5.01.48 Effective Date: May 1, 2025* Last Revised: Apr. 8, 2025 Replaces: N/...
https://www.premera.com/medicalpolicies/5.01.641.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.641 Pharmacologic Treatment of Vitiligo Effective Date: ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.644.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.644 Medical Pharmacologic Treatment of Multiple Sclerosis Effective Date: Feb. 1, 2025* Last Revised: Apr. 1, 2025 Replaces: N/A *This policy has ...
https://www.premera.com/medicalpolicies/7.01.163.pdf#search=policy
MEDICAL POLICY - 7.01.163 Absorbable Nasal Implant for Treatment of Nasal Valve Collapse BCBSA Ref. Policy: 7.01.163 Effective Date: Jan. 1, 2025 Last Revised: Dec. 9, 2024 ...
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: Mar. 1, 2025 Last Revised: Feb. 10, 2025 ...
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: Apr. 1, 2025 ...
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/5.01.559_2025-10-03.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.559 IL-5 Inhibitors Effective Date: Oct. 3, 2025* Last Revised: Jun. 10, 2025 Replaces: N/A *This policy has been revised. Click here to view the ...
https://www.premera.com/medicalpolicies/5.01.570_2025-10-03.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.570 Pharmacologic Treatment of Duchenne Muscular Dystrophy BCBSA Ref. Policy: 5.01.27 Effective Date: Oct. 3, 2025* Last Revised: Jun. 10, 2025 ...