https://www.premera.com/medicalpolicies/5.01.644.pdf#search=policy
MEDICAL POLICY - 5.01.644 Medical Pharmacologic Treatment of Multiple Sclerosis Effective ... Medical Necessity criteria within this policy DOES NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/7.01.181.pdf#search=policy
MEDICAL POLICY - 7.01.181 Permanently Implanted Prostatic Devices for Benign Prostatic Hyperplasia BCBSA Ref. Policy: 7.01.181 Effective Date: Aug. 1, 2026 Last Revised: Jul. 14, ...
https://www.premera.com/medicalpolicies/7.01.557.pdf#search=policy
MEDICAL POLICY - 7.01.557 Gender Transition/Affirmation Surgery and Related Services ... criteria within this policy DOES NOT apply to Indian Health Services (IHS) facilities. ...
https://www.premera.com/medicalpolicies/7.01.600.pdf#search=policy
MEDICAL POLICY - 7.01.600 Abdominal Wall Hernia Repair in Adults Effective Date: Jun. 1, ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/9.02.501.pdf#search=policy
MEDICAL POLICY - 9.02.501 Orthognathic Surgery Effective Date: Sep. 4, 2026 Last Revised: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/15.01.013.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.013 Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease Ref. Policy: G2110 Effective Date: Feb. 6, ...
https://www.premera.com/medicalpolicies/5.01.552.pdf#search=policy
PHARMACY POLICY - 5.01.552 Hetlioz (tasimelteon) Effective Date: Jun. 1, 2026 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.574.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.574 Pharmacotherapy of Spinal Muscular Atrophy (SMA) BCBSA Ref. Policy: 5.01.28 Effective Date: Jul. 1, 2026* Last Revised: Jun. 9, 2026 Replaces: ...
https://www.premera.com/medicalpolicies/5.01.591.pdf#search=policy
MEDICAL POLICY - 5.01.591 Immune Checkpoint Inhibitors Effective Date: Sep. 1, 2026 Last ... Medical Necessity criteria within this policy DO NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/1.01.520.pdf#search=policy
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... This policy describes when a hospital bed may be covered for use at home. Note: The ...
https://www.premera.com/medicalpolicies/5.01.559.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.559 IL-5 Inhibitors Effective Date: Sep. 1, 2026 Last ... Medical Necessity criteria within this policy DO NOT apply to Alaska fully- insured ...
https://www.premera.com/medicalpolicies/5.01.631.pdf#search=policy
Policy: 2.01.92 Effective Date: Apr. 1, 2026 Last Revised: Mar. 10, 2026 Replaces: N/A RELATED MEDICAL POLICIES: N/A Select a hyperlink below to be directed to that section. POLICY ...
https://www.premera.com/medicalpolicies/7.01.180.pdf#search=policy
MEDICAL POLICY - 7.01.180 Balloon Spacers for Treatment of Irreparable Rotator Cuffs of the Shoulder BCBSA Ref. Policy: 7.01.180 Effective Date: Jul. 1, 2026 Last Revised: Jun. 8, ...
https://www.premera.com/medicalpolicies/15.01.005.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.005 Immunohistochemistry Ref. Policy: P2018 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: None ...
https://www.premera.com/medicalpolicies/15.01.017.pdf#search=policy
1 ROUTINE TEST MANAGEMENT POLICY - 15.01.017 Testosterone Ref. Policy: G2013 Effective Date: Sep. 4, 2026 Last Revised: May 12, 2026 Replaces: N/A RELATED POLICIES: N/A Select a ...
https://www.premera.com/medicalpolicies/5.01.638.pdf#search=policy
MEDICAL POLICY - 5.01.638 Omisirge (omidubicel) BCBSA Ref. Policy: 8.01.68 Effective Date: May 1, 2026 Last Revised: Apr. 14, 2026 Replaces: N/A RELATED MEDICAL POLICIES: N/A ...
https://www.premera.com/medicalpolicies/15.01.002.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.002 Flow Cytometry Ref. Policy: F2019 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: N/A Select a ...
https://www.premera.com/medicalpolicies/10.01.518.pdf#search=policy
This policy provides background about different types of studies, outlines what services ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
https://www.premera.com/medicalpolicies/10.01.523.pdf#search=policy
below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
https://www.premera.com/medicalpolicies/15.01.008.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.008 Lyme Disease Testing Ref. Policy: G2143 Effective Date: Feb. 6, 2026 Last Revised: Apr. 1, 2026 Replaces: N/A RELATED POLICIES: N/A ...