https://www.premera.com/medicalpolicies/5.01.636.pdf#search=policy
PHARMACY/MEDICAL POLICY - 5.01.636 Chronic Hepatitis B Antiviral Therapy Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/1.01.27.pdf#search=policy
MEDICAL POLICY - 1.01.27 Electrical and Electromagnetic Stimulation for the Treatment of Arthritis BCBSA Ref. Policy: 1.01.27 Effective Date: Jun. 1, 2026 Last Revised: May 11, ...
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: Jul. 1, 2026 Last Revised: Jun. 8, 2026 Replaces: ...
https://www.premera.com/medicalpolicies/2.02.517.pdf#search=policy
MEDICAL POLICY - 2.02.517 Electrophysiology (EP) studies Effective Date: Sep. 1, 2026 ... 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: Sep. 1, 2026 Last Revised: Aug. 10, 2026 ...
https://www.premera.com/medicalpolicies/2.04.152.pdf#search=policy
MEDICAL POLICY - 2.04.152 Maternal Serum Testing for Prediction of Adverse Obstetric Outcomes BCBSA Ref. Policy: 2.04.152 Effective Date: Aug. 1, 2026 Last Revised: Oct. 1, 2026 ...
https://www.premera.com/medicalpolicies/5.01.517_2027-01-01.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.517 Use of Vascular Endothelial Growth Factor Receptor ... Jan. 1, 2027* Last Revised: Sep. 8, 2026 Replaces: N/A *This policy has been revised. ...
https://www.premera.com/medicalpolicies/5.01.653.pdf#search=policy
MEDICAL POLICY - 5.01.653 Miscellaneous Intravitreal Drugs Effective Date: Apr. 1, 2026 ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.659.pdf#search=policy
PHARMACY POLICY - 5.01.659 Antipsychotics Effective Date: Aug. 1, 2026 Last Revised: Jul. ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
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: Jul. 1, 2026 Last Revised: ...
https://www.premera.com/medicalpolicies/7.01.174.pdf#search=policy
PHARMACY / MEDICAL POLICY - 7.01.174 Stationary Ultrasonic Diathermy Devices BCBSA Ref. Policy: 7.01.174 Effective Date: Apr. 1, 2026 Last Revised: Mar. 9, 2026 Replaces: N/A ...
https://www.premera.com/medicalpolicies/7.01.175.pdf#search=policy
MEDICAL POLICY - 7.01.175 Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia BCBSA Ref. Policy: 7.01.175 Effective Date: Mar. 1, 2026 Last Revised: Feb. ...
https://www.premera.com/medicalpolicies/7.01.594.pdf#search=policy
MEDICAL POLICY - 7.01.594 Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial Disease BCBSA Ref. Policy: 7.01.178 Effective Date: Oct. 1, 2026* Last ...
https://www.premera.com/medicalpolicies/7.01.595.pdf#search=policy
MEDICAL POLICY - 7.01.595 Carpal Tunnel Release Surgical Techniques Effective Date: Jul. ... criteria within this policy DOES NOT apply to Indian Health Services (IHS) facilities. ...
https://www.premera.com/medicalpolicies/7.01.601_2026-11-06.pdf#search=policy
MEDICAL POLICY - 7.01.601 Endovascular Stent Grafts for Abdominal Aortic Aneurysms BCBSA Ref. Policy: 7.01.67 Effective Date: Nov. 6, 2026* Last Revised: Jul. 14, 2026 Replaces: ...
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 ... 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 for Ocular Disorders BCBSA Ref. Policy: 9.03.31 Effective Date: Oct. 1, 2026* Last Revised: ...
https://www.premera.com/medicalpolicies/5.01.643.pdf#search=policy
MEDICAL POLICY - 5.01.643 Prescription Digital Therapeutics for Substance Use Disorders BCBSA Ref. Policy: 5.01.35 Effective Date: Nov. 1, 2025 Last Revised: Sep. 1, 2026 ...
https://www.premera.com/medicalpolicies/2.02.518.pdf#search=policy
MEDICAL POLICY - 2.02.518 Transcatheter Tricuspid Valve Repair or Replacement BCBSA Ref. Policy: 2.02.34 Effective Date: Aug. 1, 2026 Last Revised: Jul. 13, 2026 Replaces: N/A ...
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: Sep. 1, ...