• Medical Policies

    Premera offers access to more than 300 medical policies online. Since we’re continually updating these pages, we encourage you to visit often. The policies are in Adobe PDF format. Individual plans use different medical policies. View individual plan medical policies and also View our HMO medical policies.

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467 results found for policy
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: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: N/A ...
https://www.premera.com/medicalpolicies/15.01.009.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.009 Metabolite Markers of Thiopurines Testing Ref. Policy: G2115 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/15.01.019.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.019 General Inflammation Testing Ref. Policy: G2155 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.024.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.024 Folate Testing Ref. Policy: G2154 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: N/A Select a ...
https://www.premera.com/medicalpolicies/15.01.027.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.027 Human Immunodeficiency Virus (HIV) Ref. Policy: M2116 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/15.01.028.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.028 Salivary Hormone Testing Ref. Policy: G2120 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.031.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.031 Celiac Disease Testing Ref. Policy: G2043 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.032.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.032 Helicobacter pylori Testing Ref. Policy: G2044 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.037.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.037 Onychomycosis Testing Ref. Policy: M2172 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.041.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.041 Intracellular Micronutrient Analysis Ref. Policy: G2099 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: 2.04.73 ...
https://www.premera.com/medicalpolicies/15.01.042.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.042 Serum Tumor Markers for Malignancies Ref. Policy: G2124 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/15.01.045.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.045 Prostate Biopsy Specimen Analysis Ref. Policy: G2007 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/8.03.505.pdf#search=policy
POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
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: Oct. 3, 2025 Last Revised: Jun. ...
https://www.premera.com/medicalpolicies/15.01.007.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.007 Evaluation of Dry Eyes Ref. Policy: G2138 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: N/A ...
https://www.premera.com/medicalpolicies/15.01.010.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.010 Immune Cell Function Assay Ref. Policy: G2098 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.011.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.011 Bone Turnover Markers Testing Ref. Policy: G2051 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.012.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.012 Fecal Calprotectin Testing in Adults Ref. Policy: G2061 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/15.01.018.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.018 Diagnostic Testing of Influenza Ref. Policy: G2119 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/15.01.022.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.022 Nerve Fiber Density Testing Ref. Policy: M2112 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A RELATED POLICIES: ...