https://www.premera.com/medicalpolicies/2.01.49.pdf#search=policy
PHARMACY / MEDICAL POLICY - 2.01.49 Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hyperplasia BCBSA Ref. Policy: ...
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: Feb. 1, 2023 Last Revised: ...
https://www.premera.com/medicalpolicies/5.01.605.pdf#search=policy
This policy describes coverage criteria for drugs in the plan's pharmacy prior ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
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: Aug. 1, 2022 Last Revised: July 12, 2022 Replaces: N/A ...
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, 2022 Last Revised: May 10, ...
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, 2023 Last Revised: Feb. ...
https://www.premera.com/medicalpolicies/5.01.560.pdf#search=policy
POLICIES: 10.01.511 Medical Policy and Clinical Guidelines: Definitions and Procedures Select a hyperlink below to be directed to that section. POLICY CRITERIA | DOCUMENTATION ...
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/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: Jan. 1, 2023 ...
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: Sept. 1, 2022 Last ...
https://www.premera.com/medicalpolicies/4.01.502.pdf#search=policy
MEDICAL POLICY - 4.01.502 Surgical Interruption of Pelvic Nerve Pathways for Chronic Pelvic Pain BCBSA Ref Policy: 4.01.17 Effective Date: Oct. 1, 2022 Last Revised: Sept. 12, ...
https://www.premera.com/medicalpolicies/5.01.626.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.626 Amyloid Antibodies for the Treatment of Alzheimer's Disease BCBSA Ref. Policy: 5.01.38 Effective Date: Dec. 1, 2022 Last Revised: Nov. 21, ...
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, 2022 Last ...
https://www.premera.com/medicalpolicies/8.01.502.pdf#search=policy
Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The rest of the policy uses specific words and concepts familiar to ...
https://www.premera.com/medicalpolicies/11.01.522.pdf#search=policy
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy describes skilled hourly care and outlines how the plan may cover these ...
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, 2022 ...
https://www.premera.com/medicalpolicies/7.01.584.pdf#search=policy
MEDICAL POLICY - 7.01.584 Nerve Repair for Peripheral Nerve Injuries Using Synthetic ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/3.01.521.pdf#search=policy
below to be directed to that section. POLICY CRITERIA | CODING | EVIDENCE REVIEW | ... This policy supplements the medical necessity criteria by indicating what types of ...
https://www.premera.com/medicalpolicies/9.02.503.pdf#search=policy
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... In some cases, other imaging such as MRI or ultrasound, are needed. This policy explains ...
https://www.premera.com/medicalpolicies/9.02.506.pdf#search=policy
below to be redirected to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ... This policy describes when dental restorations are covered. Cosmetic dental restorations ...