• Medical Policies

    Premera offers access to more than 300 medical policies online. Since we’re continually updating these pages, we encourage you to visit often. The policies are in Adobe PDF format. Individual plans use different medical policies. View individual plan medical policies and also View our HMO medical policies.

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378 results found for policy
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, 2025 Last Revised: Dec. 9, 2024 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/7.01.567_2025-03-05.pdf#search=policy
MEDICAL POLICY - 7.01.567 Surgical Treatments for Lymphedema and Lipedema BCBSA Ref. Policy: 7.01.162, 7.01.169, 7.01.173 Effective Date: March 5, 2025* Last Revised: Nov. 12, ...
https://www.premera.com/medicalpolicies/9.03.508.pdf#search=policy
MEDICAL POLICY - 9.03.508 Orthoptic Training for the Treatment of Vision or Learning Disabilities BCBSA Ref. Policy: 9.03.03 Effective Date: June 1, 2024 Last Revised: May 13, ...
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, 2024 Last Revised: May 13, 2024 Replaces: ...
https://www.premera.com/medicalpolicies/2.04.521.pdf#search=policy
MEDICAL POLICY - 2.04.521 Evaluation of Biomarkers for Alzheimer Disease BCBSA Ref. Policy: 2.04.14 Effective Date: Jan. 1, 2025* Last Revised: Dec. 10, 2024 Replaces: N/A *This ...
https://www.premera.com/medicalpolicies/5.01.593_2025-05-06.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.593 Pharmacologic Treatment of Transthyretin-Mediated Amyloidosis BCBSA Ref. Policy: 5.01.30 Effective Date: May 6, 2025* Last Revised: Jan. 14, ...
https://www.premera.com/medicalpolicies/7.01.144.pdf#search=policy
MEDICAL POLICY - 7.01.144 Patient-Specific Instrumentation (e.g., Cutting Guides) for Joint Arthroplasty BCBSA Ref. Policy: 7.01.144 Effective Date: July 1, 2024 Last Revised: ...
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/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, 2024 ...
https://www.premera.com/medicalpolicies/1.03.04.pdf#search=policy
MEDICAL POLICY - 1.03.04 Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities BCBSA Ref. Policy: 1.03.04 Effective Date: June 1, 2024 Last Revised: May 13, ...
https://www.premera.com/medicalpolicies/2.02.24.pdf#search=policy
MEDICAL POLICY - 2.02.24 Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting BCBSA Ref. Policy: 2.02.24 Effective Date: Aug. 1, 2024 Last ...
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: Sept. 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, 2024 Last Revised: Dec, 23, ...
https://www.premera.com/medicalpolicies/2.04.515.pdf#search=policy
MEDICAL POLICY - 2.04.515 Plasma-based Proteomic Screening in the Management of Pulmonary Nodules BCBSA Ref. Policy: 2.04.142 Effective Date: Aug. 1, 2024 Last Revised: July 8, ...
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/5.01.615.pdf#search=policy
PHARMACY POLICY - 5.01.615 Pharmacologic Treatment of Chronic Non-Infectious Liver ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.633.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.633 Intraarticular Corticosteroids Effective Date: Aug. ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.634.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.634 Gene Therapies for Cerebral Adrenoleukodystrophy BCBSA Ref. Policy: 5.01.45 Effective Date: Sept. 1, 2024 Last Revised: Aug. 26, 2024 ...
https://www.premera.com/medicalpolicies/7.01.147.pdf#search=policy
MEDICAL POLICY - 7.01.147 Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas BCBSA Ref. Policy: 7.01.147 Effective Date: Oct. 1, 2024 Last Revised: ...
https://www.premera.com/medicalpolicies/7.01.78.pdf#search=policy
MEDICAL POLICY - 7.01.78 Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions BCBSA Ref. Policy: 7.01.78 Effective Date: July 1, 2024 Last Revised: June ...