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, 2024 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, 2024 Last Revised: Sept. ...
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, 2024 Last Revised: Jan. 1, 2025 ...
https://www.premera.com/medicalpolicies/5.01.42.pdf#search=policy
MEDICAL POLICY - 5.01.42 Gene Therapies for Thalassemia BCBSA Ref. Policy: 5.01.42 Effective Date: June 1, 2024 Last Revised: Jan. 1, 2025 Replaces: N/A RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/5.01.572.pdf#search=policy
PHARMACY POLICY - 5.01.572 Coverage Criteria for Excluded and Non-Formulary Drugs ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/5.01.573.pdf#search=policy
PHARMACY POLICY - 5.01.573 Pharmacotherapy of Perinatal/Infantile and Juvenile-Onset ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.586.pdf#search=policy
MEDICAL POLICY - 5.01.586 Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders BCBSA Ref. Policy: 5.01.16 Effective Date: Feb. 1, ...
https://www.premera.com/medicalpolicies/5.01.618.pdf#search=policy
MEDICAL / PHARMACY POLICY - 5.01.618 Selective Estrogen Receptor Modulators and Down ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.620.pdf#search=policy
MEDICAL POLICY - 5.01.620 Vascular Endothelial Growth Factor (VEGF) Receptor Inhibitors ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.632.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.632 Pharmacologic Treatment of Bladder Cancer Effective ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.636.pdf#search=policy
PHARMACY POLICY - 5.01.636 Chronic Hepatitis B Antiviral Therapy Effective Date: July 1, ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.642.pdf#search=policy
MEDICAL POLICY - 5.01.642 Gene Therapies for Rare Diseases BCBSA Ref. Policy: 5.01.49 Effective Date: Aug. 1, 2024 Last Revised: July 9, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.647.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.647 Medical Necessity Criteria for Custom Incentive and ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/6.01.68.pdf#search=policy
MEDICAL POLICY - 6.01.68 Irreversible Electroporation of Tumors Located in the Liver, Pancreas, Kidney, or Lung BCBSA Ref. Policy: 6.01.68 Effective Date: Jan. 1, 2025 Last ...
https://www.premera.com/medicalpolicies/7.01.563.pdf#search=policy
MEDICAL POLICY - 7.01.563 Ablative Treatments for Occipital Neuralgia, Chronic Headaches, ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/7.01.574.pdf#search=policy
MEDICAL POLICY - 7.01.574 Implantable Peripheral Nerve Stimulation for the Treatment of Chronic Pain and Other Conditions BCBSA Ref. Policy 1.01.31, 7.01.29, 7.01.106 Effective ...
https://www.premera.com/medicalpolicies/7.01.587.pdf#search=policy
MEDICAL POLICY - 7.01.587 Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures) BCBSA Ref. Policy: 7.01.14 Effective Date: ...
https://www.premera.com/medicalpolicies/10.01.503.pdf#search=policy
below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ... This policy explains some of the circumstances when anesthesia may be covered by a ...
https://www.premera.com/medicalpolicies/11.01.523.pdf#search=policy
Feb. 1, 2025* Last Revised: Jan. 27, 2025 Replaces: N/A *This policy has been revised. ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/11.01.523_2025-05-06.pdf#search=policy
Infusion Drugs and Biologic Agents Effective Date: May 6, 2025* Last Revised: Jan. 27, 2025 Replaces: N/A *This policy has been updated. Click here to view the current policy. ...