https://www.premera.com/medicalpolicies/2.02.515.pdf#search=policy
MEDICAL POLICY - 2.02.515 Leadless Cardiac Pacemakers BCBSA Ref. Policy: 2.02.32 Effective Date: Sept. 1, 2023 Last Revised: Jan. 1, 2024 Replaces: 2.02.32 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/5.01.512.pdf#search=policy
MEDICAL POLICY - 5.01.512 Botulinum Toxins Effective Date: Feb. 7, 2024 Last Revised: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | APPENDIX | ...
https://www.premera.com/medicalpolicies/5.01.553.pdf#search=policy
PHARMACY POLICY - 5.01.553 Myalept ® (metreleptin) Effective Date: June 1, 2023 Last ... below to be directed to that section. POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | ...
https://www.premera.com/medicalpolicies/5.01.552.pdf#search=policy
PHARMACY POLICY - 5.01.552 Hetlioz® (tasimelteon) Effective Date: June 1, 2023 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/5.01.561.pdf#search=policy
MEDICAL POLICY - 5.01.561 Repository Corticotropin Injection BCBSA Ref. Policy: 5.01.17 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 Replaces: 5.01.17 RELATED MEDICAL ...
https://www.premera.com/medicalpolicies/6.01.38.pdf#search=policy
MEDICAL POLICY - 6.01.38 Percutaneous Balloon Kyphoplasty, Radiofrequency Kyphoplasty, and Mechanical Vertebral Augmentation BCBSA Ref. Policy: 6.01.38 Effective Date: Aug. 1, 2023 ...
https://www.premera.com/medicalpolicies/7.01.126.pdf#search=policy
MEDICAL POLICY - 7.01.126 Image-Guided Minimally Invasive Decompression for Spinal Stenosis BCBSA Ref. Policy: 7.01.126 Effective Date: July 1, 2023 Last Revised: June 12, 2023 ...
https://www.premera.com/medicalpolicies/7.01.573.pdf#search=policy
MEDICAL POLICY - 7.01.573 Hip Arthroplasty in Adults Effective Date: Jan. 1, 2024 Last ... POLICY CRITERIA | DOCUMENTATION REQUIREMENTS | CODING RELATED INFORMATION | EVIDENCE ...
https://www.premera.com/medicalpolicies/7.01.588.pdf#search=policy
MEDICAL POLICY - 7.01.588 Percutaneous Electrical Nerve Stimulationand Percutaneous Neuromodulation Therapy BCBSA Ref. Policy: 7.01.29 Effective Date: Oct. 1, 2023 Last Revised: ...
https://www.premera.com/medicalpolicies/7.01.83.pdf#search=policy
MEDICAL POLICY - 7.01.83 Auditory Brainstem Implant BCBSA Ref. Policy: 7.01.83 Effective Date: May 1, 2023 Last Revised: April 10, 2023 Replaces: N/A RELATED MEDICAL POLICIES: ...
https://www.premera.com/medicalpolicies/7.03.07.pdf#search=policy
MEDICAL POLICY - 7.03.07 Lung and Lobar Lung Transplant BCBSA Ref. Policy: 7.03.07 Effective Date: Nov. 1, 2023 Last Revised: Oct. 9, 2023 Replaces: Extracted from 7.03.509 ...
https://www.premera.com/medicalpolicies/8.01.531.pdf#search=policy
MEDICAL POLICY - 8.01.531 Hematopoietic Cell Transplantation for Waldenström Macroglobulinemia BCBSA Ref. Policy: 8.01.54 Effective Date: Jan. 1, 2024 Last Revised: Dec. 11, 2023 ...
https://www.premera.com/medicalpolicies/8.01.55.pdf#search=policy
MEDICAL POLICY - 8.01.55 Stem Cell Therapy for Peripheral Arterial Disease BCBSA Ref. Policy: 8.01.55 Effective Date: Apr. 1, 2023 Last Revised: Mar. 20, 2023 Replaces: N/A ...
https://www.premera.com/medicalpolicies/5.01.533.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.533 mTOR Kinase Inhibitors Effective Date: July 1, 2023 ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...
https://www.premera.com/medicalpolicies/5.01.544.pdf#search=policy
PHARMACY / MEDICAL POLICY - 5.01.544 Prostate Cancer Targeted Therapies Effective Date: ... POLICY CRITERIA | CODING | RELATED INFORMATION EVIDENCE REVIEW | REFERENCES | HISTORY ∞ ...
https://www.premera.com/medicalpolicies/10.01.520.pdf#search=policy
BENEFIT COVERAGE GUIDELINE - 10.01.520 Review for Coverage in the Absence of a Medical Policy, Pharmacy Policy, or Utilization Management Guideline Effective Date: Apr. 1, 2023 ...
https://www.premera.com/medicalpolicies/2.02.09.pdf#search=policy
MEDICAL POLICY - 2.02.09 Closure Devices for Patent Foramen Ovale and Atrial Septal Defects BCBSA Ref. Policy: 2.02.09 Effective Date: Aug. 1, 2023 Last Revised: July 10, 2023 ...
https://www.premera.com/medicalpolicies/2.04.520.pdf#search=policy
MEDICAL POLICY - 2.04.520 Laboratory Testing Investigational Services BCBSA Ref. Policy: 2.04.159 Effective Date: Jan. 1, 2024* Last Revised: Dec. 11, 2023 Replaces: N/A *This ...
https://www.premera.com/medicalpolicies/2.04.62.pdf#search=policy
MEDICAL POLICY - 2.04.62 Multimarker Serum Testing Related to Ovarian Cancer BCBSA Ref. Policy: 2.04.62 Effective Date: Mar. 1. 2024 Last Revised: Feb. 12, 2024 Replaces: N/A ...
https://www.premera.com/medicalpolicies/3.01.510.pdf#search=policy
MEDICAL POLICY - 3.01.510 Applied Behavior Analysis (ABA) Effective Date: Jan. 1, 2024 ... below to be directed to that section. POLICY CRITERIA | CODING | RELATED INFORMATION ...