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/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/15.01.030.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.030 Diagnostic Testing of Iron Homeostasis and Metabolism Ref. Policy: G2011 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 ...
https://www.premera.com/medicalpolicies/15.01.040.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.040 Biomarker Testing for Autoimmune Rheumatic Disease Ref. Policy: G2022 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: ...
https://www.premera.com/medicalpolicies/15.01.043.pdf#search=policy
1 ROUTINE TEST MANAGEMENT POLICY - 15.01.043 Pathogen Panel Testing Ref. Policy: G2149 Effective Date: Feb. 6, 2026 Last Revised: Jun. 17, 2026 Replaces: N/A RELATED POLICIES: ...
https://www.premera.com/medicalpolicies/15.01.048.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.048 Testing for Alpha-1 Antitrypsin Deficiency Ref. Policy: M2068 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.575.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.575 Dupixent (dupilumab) Effective Date: Jul. 1, 2026 ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.648.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.648 Insulin Therapy Effective Date: Aug. 1, 2026 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/15.01.006.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.006 Parathyroid Hormone, Phosphorus, Calcium, and Magnesium Testing Ref. Policy: G2164 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, ...
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/15.01.021.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.021 Gamma-glutamyl Transferase Testing in Adults Ref. Policy: G2173 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/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: Feb. 6, 2026 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/15.01.029.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.029 Vitamin B12 and Methylmalonic Acid Testing Ref. Policy: G2014 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/15.01.038.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.038 In Vitro Chemoresistance and Chemosensitivity Assays Ref. Policy: G2100 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 Replaces: ...
https://www.premera.com/medicalpolicies/15.01.044.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.044 Therapeutic Drug Monitoring for 5-Fluorouracil Ref. Policy: M2067 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/15.01.047.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.047 Venous and Arterial Thrombosis Risk Testing Ref. Policy: M2041 Effective Date: Feb. 6, 2026 Last Revised: Oct. 14, 2025 Replaces: N/A ...
https://www.premera.com/medicalpolicies/15.01.049.pdf#search=policy
ROUTINE TEST MANAGEMENT POLICY - 15.01.049 Testing of Homocysteine Metabolism-Related Conditions Ref. Policy: M2141 Effective Date: Feb. 6, 2026 Last Revised: Feb. 6, 2026 ...
https://www.premera.com/medicalpolicies/4.02.503.pdf#search=policy
Assisted Reproduction Services BCBSA Ref. Policy 4.02.04 Effective Date: Jun. 1, 2026 Last ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
https://www.premera.com/medicalpolicies/5.01.614.pdf#search=policy
MEDICAL POLICY - 5.01.614 Erythroid Maturation Agents Effective Date: May 1, 2026 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
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 ...