https://www.premera.com/medicalpolicies/2.04.515.pdf#search=policy
MEDICAL POLICY - 2.04.515 Plasma-based Proteomic Screening in the Management of Pulmonary Nodules BCBSA Ref. Policy: 2.04.142 Effective Date: Aug. 1, 2024 Last Revised: July 8, ...
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/5.01.647.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.647 Medical Necessity Criteria for Custom Open 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/7.01.168.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, 2025 Last ...
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/7.01.597.pdf#search=policy
MEDICAL POLICY - 7.01.597 Radiofrequency Volumetric Tissue Reduction for Nasal Obstruction BCBSA Ref. Policy: 7.01.156 Effective Date: May 1, 2025 Last Revised: Apr. 8, 2025 ...
https://www.premera.com/medicalpolicies/5.01.640_2025-10-03.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.640 Pharmacologic Treatment of Sickle Cell Disease BCBSA Ref. Policy: 5.01.48 Effective Date: Oct. 3, 2025* Last Revised: Jun. 10, 2025 Replaces: ...
https://www.premera.com/medicalpolicies/5.01.644_2025-10-03.pdf#search=policy
POLICY - 5.01.644 Medical Pharmacologic Treatment of Multiple Sclerosis Effective Date: Oct. 3, 2025* Last Revised: Jun. 10, 2025 Replaces: N/A *View the current policy here. ...
https://www.premera.com/medicalpolicies/11.01.523.pdf#search=policy
May 6, 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/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 BCBSA Ref. Policy: 2.04.26 Effective Date: Mar. 1, 2025 Last Revised: Feb. 10, 2025 Replaces: N/A ...
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, 2024 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, 2024 Last ...
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: May 1, 2025 Last Revised: Apr. 21, 2025 ...
https://www.premera.com/medicalpolicies/5.01.635.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.635 Pharmacologic Treatment of Epidermolysis Bullosa BCBSA Ref. Policy: 5.01.47 Effective Date: Mar. 1, 2025 Last Revised: Feb. 24, 2025 Replaces: ...
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: Apr. 1, 2025 ...
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/7.01.587.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/7.01.596.pdf#search=policy
MEDICAL POLICY - 7.01.596 Adjunctive Techniques for Screening, Surveillance, and Risk Classification of Barrett Esophagus and Esophageal Dysplasia BCBSA Ref. Policy: 7.01.167 ...