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: Aug. 1, 2026 Last Revised: Jul. ...
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, 2025 Last Revised: Sep. ...
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: Jun. 1, 2026 Last Revised: May 11, ...
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/11.01.525.pdf#search=policy
Policy: N/A Effective Date: Sep. 1, 2026 Last Revised: Jun. 16, 2026 Replaces: N/A RELATED ... criteria within this policy DO NOT apply to Indian Health Services (IHS) facilities. ...
https://www.premera.com/medicalpolicies/2.01.107.pdf#search=policy
MEDICAL POLICY - 2.01.107 Fractional Carbon Dioxide (CO2) Laser Ablation Treatment of Hypertrophic Scars or Keloids for Functional Improvement BCBSA Ref. Policy: 2.01.107 Effective ...
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: Jul. 1, ...
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/7.01.574.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/1.01.529.pdf#search=policy
This policy explains when durable medical equipment is covered. Note: The Introduction section is for your general knowledge and is not to be taken as policy coverage criteria. The ...
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/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: Jan. 1, 2026 Last ...
https://www.premera.com/medicalpolicies/3.03.523.pdf#search=policy
PHARMACY / MEDICAL POLICY - 3.03.523 Prescription Digital Health Diagnostic Aid for Autism Spectrum Disorder BCBSA Ref. Policy: 3.03.01 Effective Date: May 1, 2026 Last Revised: ...
https://www.premera.com/medicalpolicies/4.01.502.pdf#search=policy
MEDICAL POLICY - 4.01.502 Surgical Interruption of Pelvic Nerve Pathways for Chronic ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
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: Sep. 1, 2026 Last Revised: Aug. 10, 2026 Replaces: N/A RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/5.01.544.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.544 Prostate Cancer Targeted Therapies Effective Date: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | APPENDIX | REFERENCES | ...
https://www.premera.com/medicalpolicies/5.01.569.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.569 Pharmacotherapy of Type 1 and Type 2 Diabetes ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/5.01.570.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.570 Pharmacologic Treatment of Duchenne Muscular Dystrophy BCBSA Ref. Policy: 5.01.27 & 5.01.46 Effective Date: May 1, 2026 Last Revised: Apr. 27, ...
https://www.premera.com/medicalpolicies/5.01.608.pdf#search=policy
PHARMACY - 5.01.608 Pharmacologic Treatment of Postpartum Depression BCBSA Ref. Policy: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS RELATED INFORMATION | EVIDENCE REVIEW | ...