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/5.01.620.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/5.01.634.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.634 Gene Therapies for Cerebral Adrenoleukodystrophy ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
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 7.01.29, 7.01.106 Effective Date: Nov. 1, ...
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/2.01.49.pdf#search=policy
MEDICAL POLICY - 2.01.49 Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia BCBSA Ref. Policy: 2.01.49 ...
https://www.premera.com/medicalpolicies/2.04.26.pdf#search=policy
MEDICAL POLICY - 2.04.26 Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Irritable Bowel Syndrome BCBSA Ref. Policy: 2.04.26 Effective Date: Mar. 1, 2024 Last Revised: ...
https://www.premera.com/medicalpolicies/3.03.01.pdf#search=policy
PHARMACY / MEDICAL POLICY - 3.03.01 Prescription Digital Health Diagnostic Aid for Autism Spectrum Disorder BCBSA Ref. Policy: 3.03.01 Effective Date: Oct. 1, 2023 Last Revised: ...
https://www.premera.com/medicalpolicies/3.03.03.pdf#search=policy
PHARMACY / MEDICAL POLICY - 3.03.03 Prescription Digital Therapeutics for Attention Deficit/Hyperactivity Disorder BCBSA Ref. Policy: 3.03.03 Effective Date: Oct. 1, 2023 Last ...
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/5.01.643.pdf#search=policy
MEDICAL POLICY - 5.01.643 Prescription Digital Therapeutics for Substance Use Disorders BCBSA Ref. Policy: 5.01.35 Effective Date: Feb. 1, 2024 Last Revised: Jan. 9, 2024 ...
https://www.premera.com/medicalpolicies/7.01.167.pdf#search=policy
MEDICAL POLICY - 7.01.167 Adjunctive Techniques for Screening and Surveillance of Barrett Esophagus and Esophageal Dysplasia BCBSA Ref. Policy: 7.01.167 Effective Date: Oct. 1, 2023 ...
https://www.premera.com/medicalpolicies/7.01.168.pdf#search=policy
MEDICAL POLICY - 7.01.168 Cryoablation, Radiofrequency Ablation, and Laser Ablation for Treatment of Chronic Rhinitis BCBSA Ref. Policy: 7.01.168 Effective Date: May 1, 2023 Last ...
https://www.premera.com/medicalpolicies/7.01.172.pdf#search=policy
MEDICAL POLICY - 7.01.172 Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation BCBSA Ref. Policy: 7.01.172 Effective Date: Nov. 1, 2023 ...
https://www.premera.com/medicalpolicies/7.01.533.pdf#search=policy
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | REFERENCES | ... This policy describes when breast reconstruction is covered to address a medical ...
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/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: June 1, 2023 Last Revised: May 5, ...
https://www.premera.com/medicalpolicies/11.01.508.pdf#search=policy
below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ... not cover non-skilled home care.) This policy describes when home health care services ...
https://www.premera.com/medicalpolicies/11.01.523.pdf#search=policy
April 1, 2024* Last Revised: Mar. 12, 2024 Replaces: N/A *This policy has been updated. View the upcoming policy changes here for June 7, 2024. View the upcoming policy changes ...