https://www.premera.com/medicalpolicies/1.04.503.pdf#search=policy
MEDICAL POLICY - 1.04.503 Microprocessor-Controlled and Powered Prostheses and Orthoses for the Lower Limb BCBSA Ref. Policy: 1.04.05 Effective Date: April 1, 2024 Last Revised: ...
https://www.premera.com/medicalpolicies/10.01.512.pdf#search=policy
MEDICAL POLICY - 10.01.512 Ambulance and Medical Transport Services Effective Date: April ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/2.01.40.pdf#search=policy
MEDICAL POLICY - 2.01.40 Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions BCBSA Ref. Policy: 2.01.40 Effective Date: Sept. 1, 2023 ...
https://www.premera.com/medicalpolicies/2.02.30.pdf#search=policy
MEDICAL POLICY - 2.02.30 Transcatheter Mitral Valve Repair BCBSA Ref. Policy: 2.02.30 Effective Date: Aug. 1, 2023 Last Revised: Jan. 1, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/2.02.510.pdf#search=policy
MEDICAL POLICY - 2.02.510 Mobile Cardiac Outpatient Telemetry BCBSA Ref. Policy: 2.02.08 Effective Date: Feb. 1, 2024 Last Revised: Jan. 9, 2024 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.521_2024-07-04.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.521 Pharmacologic Treatment of Neuropathy, Fibromyalgia, ... July 4, 2024* Last Revised: Mar. 12, 2024 Replaces: N/A *View the current policy here. ...
https://www.premera.com/medicalpolicies/5.01.522.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.522 Advanced Therapies for Pharmacological Treatment of Pulmonary Arterial Hypertension BCBSA Ref. Policy: 5.01.09 Effective Date: Feb. 1, 2024 ...
https://www.premera.com/medicalpolicies/5.01.530.pdf#search=policy
MEDICAL POLICY - 5.01.530 Egrifta SV® (tesamorelin) Effective Date: June 1, 2023 Last ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/5.01.534.pdf#search=policy
PHARMACY POLICY - 5.01.534 Multiple Receptor Tyrosine Kinase Inhibitors Effective Date: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/6.01.25.pdf#search=policy
MEDICAL POLICY - 6.01.25 Percutaneous Vertebroplasty and Sacroplasty BCBSA Ref. Policy: 6.01.25 Effective Date: July 1, 2023 Last Revised: June 12, 2023 Replaces: 6.01.520 RELATED ...
https://www.premera.com/medicalpolicies/6.01.46.pdf#search=policy
MEDICAL POLICY - 6.01.46 Dynamic Spinal Visualization and Vertebral Motion Analysis BCBSA Ref. Policy: 6.01.46 Effective Date: Dec. 1, 2023 Last Revised: Nov. 6, 2023 Replaces: ...
https://www.premera.com/medicalpolicies/7.01.107.pdf#search=policy
MEDICAL POLICY - 7.01.107 Interspinous and Interlaminar Stabilization/Distraction Devices (Spacers) BCBSA Ref. Policy: 7.01.107 Effective Date: July 1, 2023 Last Revised: June 12, ...
https://www.premera.com/medicalpolicies/7.01.130.pdf#search=policy
MEDICAL POLICY - 7.01.130 Axial Lumbosacral Interbody Fusion BCBSA Ref. Policy: 7.01.130 Effective Date: July 1, 2023 Last Revised: June 12, 2023 Replaces: N/A RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/7.01.548.pdf#search=policy
MEDICAL POLICY - 7.01.548 Hysterectomy for Non-Malignant Conditions Effective Date: Mar. ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.550.pdf#search=policy
MEDICAL POLICY - 7.01.550 Knee Arthroplasty in Adults Effective Date: Jan. 1, 2024 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.551.pdf#search=policy
MEDICAL POLICY - 7.01.551 Lumbar Spine Decompression Surgery: Discectomy, Foraminotomy, ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.562.pdf#search=policy
MEDICAL POLICY - 7.01.562 Intraoperative Neurophysiologic Monitoring BCBSA Ref. Policy: 7.01.58 Effective Date: July 1, 2023 Last Revised: June 13, 2023 Replaces: 7.01.58 RELATED ...
https://www.premera.com/medicalpolicies/7.03.01.pdf#search=policy
MEDICAL POLICY - 7.03.01 Kidney Transplant BCBSA Ref. Policy: 7.03.01 Effective Date: Oct. 1, 2023 Last Revised: Sept. 25, 2023 Replaces: Extracted from 7.03.509 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/8.01.53.pdf#search=policy
MEDICAL POLICY - 8.01.53 Cellular Immunotherapy for Prostate Cancer BCBSA Ref. Policy: 8.01.53 Effective Date: Oct. 1, 2023 Last Revised: Sept. 11, 2023 Replaces: N/A RELATED ...
https://www.premera.com/medicalpolicies/8.01.539.pdf#search=policy
MEDICAL POLICY - 8.01.539 Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms BCBSA Ref. Policy: 8.01.21 Effective Date: ...