https://www.premera.com/medicalpolicies/8.03.01.pdf#search=policy
MEDICAL POLICY - 8.03.01 Functional Neuromuscular Electrical Stimulation BCBSA Ref. Policy: 8.03.01 Effective Date: June 1, 2023 Last Revised: May 5, 2023 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/5.01.540.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.540 Miscellaneous Oncology Drugs Effective Date: Mar. 1, ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.550.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.550 Pharmacotherapy of Arthropathies Effective Date: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/2.01.57.pdf#search=policy
MEDICAL POLICY - 2.01.57 Electrostimulation and Electromagnetic Therapy for Treating Wounds BCBSA Ref. Policy: 2.01.57 Effective Date: Mar. 1, 2024 Last Revised: Feb. 26, 2024 ...
https://www.premera.com/medicalpolicies/2.01.73.pdf#search=policy
MEDICAL POLICY - 2.01.73 Actigraphy BCBSA Ref. Policy: 2.01.73 Effective Date: Sept. 1, 2023 Last Revised: Aug. 7, 2023 Replaces: N/A RELATED MEDICAL POLICIES: None Select a ...
https://www.premera.com/medicalpolicies/5.01.639.pdf#search=policy
MEDICAL POLICY - 5.01.639 Immune Prophylaxis for Respiratory Syncytial Virus BCBSA Ref. Policy: 5.01.10 Effective Date: Nov. 1, 2023 Last Revised: Oct. 10, 2023 Replaces: 5.01.10 ...
https://www.premera.com/medicalpolicies/7.01.104.pdf#search=policy
MEDICAL POLICY - 7.01.104 Subtalar Arthroereisis BCBSA Ref. Policy: 7.01.104 Effective Date: July 1, 2023 Last Revised: June 12, 2023 Replaces: N/A RELATED MEDICAL POLICIES: None ...
https://www.premera.com/medicalpolicies/7.03.11.pdf#search=policy
MEDICAL POLICY - 7.03.11 Total Artificial Hearts and Implantable Ventricular Assist Devices BCBSA Ref. Policy: 7.03.11 Effective Date: Nov. 1, 2023 Last Revised: Oct. 9, 2023 ...
https://www.premera.com/medicalpolicies/8.01.24.pdf#search=policy
MEDICAL POLICY - 8.01.24 Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults BCBSA Ref. Policy: 8.01.24 Effective Date: Apr. 1, 2023 Last Revised: Mar. 6, ...
https://www.premera.com/medicalpolicies/8.01.511.pdf#search=policy
MEDICAL POLICY - 8.01.511 Hematopoietic Cell Transplantation for Solid Tumors of Childhood BCBSA Ref. Policy: 8.01.34 Effective Date: April 1, 2023 Last Revised: Mar. 20, 2023 ...
https://www.premera.com/medicalpolicies/8.03.501.pdf#search=policy
MEDICAL POLICY - 8.03.501 Chiropractic and Other Manipulation Services Effective Date: ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/9.02.500.pdf#search=policy
MEDICAL POLICY - 9.02.500 Orthodontic Services for Treatment of Congenital Craniofacial ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/10.01.511.pdf#search=policy
ADMINISTRATIVE GUIDELINE - 10.01.511 Medical Policy and Clinical Guidelines: Definitions ... section is for your general knowledge and is not to be taken as policy coverage criteria. ...
https://www.premera.com/medicalpolicies/2.01.17.pdf#search=policy
MEDICAL POLICY - 2.01.17 Sublingual Immunotherapy as a Technique of Allergen- Specific Therapy BCBSA Ref Policy: 2.01.17 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 ...
https://www.premera.com/medicalpolicies/5.01.514.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.514 Herceptin (trastuzumab) and Other HER2 Inhibitors ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.603.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.603 Epidermal Growth Factor Receptor (EGFR) Inhibitors ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.84.pdf#search=policy
MEDICAL POLICY - 7.01.84 Semi-Implantable and Fully Implantable Middle Ear Hearing Aids BCBSA Ref. Policy: 7.01.84 Effective Date: May 1, 2023 Last Revised: April 10, 2023 ...
https://www.premera.com/medicalpolicies/7.03.12.pdf#search=policy
MEDICAL POLICY - 7.03.12 Islet Transplantation BCBSA Ref. Policy: 7.03.12 Effective Date: Nov. 1, 2022 Last Revised: Oct. 24, 2022 Replaces: N/A RELATED MEDICAL POLICIES: 7.03.02 ...
https://www.premera.com/medicalpolicies/8.01.521.pdf#search=policy
MEDICAL POLICY - 8.01.521 Radioembolization for Primary and Metastatic Tumors of the Liver BCBSA Ref. Policy: 8.01.43 Effective Date: Oct. 1, 2023 Last Revised: Sept. 11, 2023 ...
https://www.premera.com/medicalpolicies/5.01.520.pdf#search=policy
PHARMACY POLICY - 5.01.520 Antidepressants: Pharmacy Medical Necessity Criteria for ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...