Medical Policies

Access policies for members of other Blue Cross plans

By accessing our medical policies, you signify your agreement to our Terms of Use. Learn more about how medical policies are developedOpen a PDFand about experimental & investigational procedures .

Please refer member-specific questions to the Customer Care number on the back of the member card. Final determination of coverage is subject to the member’s benefits and eligibility on the date of service.

Make a comment

We invite practitioners to review & comment on our policies

or
Showing 101– 150 of 346 Results
Title Last Updated Category
Photodynamic Therapy for Malignant Disease Open a PDF 8.01.06 2026-04-28 Cancer Treatment (Oncology)
Pharmacogenetics Open a PDF 2.02.30 2026-04-14 Genetic Disease (Inherited Disease)
Peroral Endoscopic Myotomy (POEM) Procedures Open a PDF 7.01.120 2026-02-13 Digestive System (Gastroenterology)
Periodontal Scaling and Root Planing Open a PDF 13.01.04 2026-07-21 Dental
Periodontal Maintenance Open a PDF 13.01.05 2026-07-21 Dental
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty (Effective 2026-10-15) Open a PDF 6.01.17 2026-07-15 Bone & Joints (Orthopedic)
Percutaneous Vertebroplasty/Mechanical Vertebral Augmentation and Percutaneous Sacroplasty Open a PDF 6.01.17 2026-07-15 Bone & Joints (Orthopedic)
Pelvic Floor Electrical Stimulation as a Treatment for Urinary or Fecal Incontinence Open a PDF 1.01.19 2026-03-24 Urinary System (Genitourinary)
Patient Lifts (e.g., Hoyer, Saralift, Seat Lift, Chair Mechanisms, and Ceiling Lifts) Open a PDF 1.01.08 2026-09-14 Home Care
Patient Lifts (Effective 2026-11-16) Open a PDF 1.01.08 2026-09-14 Home Care
Partial Hospitalization for Substance Use Disorders Open a PDF 3.01.18 2026-08-25 Behavioral Health (Psychiatry/Psychology)
Pancreas Transplant: (Pancreas Transplant Alone, Pancreas Transplant after Kidney Transplant, Simultaneous Pancreas Kidney Transplant): Islet Cell Transplant Open a PDF 7.02.01 2026-03-24 Transplants
Pain Management Techniques for Knee Pain Open a PDF 7.01.100 2026-07-21 Bone & Joints (Orthopedic)
Pacemakers and Cardiac Resynchronization Therapy (CRT) Devices Open a PDF 7.01.58 2026-03-13 Heart & Blood Vessels (Cardiovascular)
Ovarian and Internal Iliac Vein Endovascular Occlusion as a Treatment of Pelvic Congestion Syndrome Open a PDF 4.01.10 2026-09-21 Women's Health (Obstetrics & Gynecology)
Out-of-Network Services Open a PDF 11.01.13 2026-01-27 Miscellaneous
Osteochondral Grafting of the Knee (Effective 2026-10-15) Open a PDF 7.01.59 2026-07-15 Bone & Joints (Orthopedic)
Osteochondral Grafting of the Knee Open a PDF 7.01.59 2026-07-15 Bone & Joints (Orthopedic)
Orthotics Open a PDF 1.01.25 2026-05-15 Bone & Joints (Orthopedic)
Orthopedic Joint Procedures of the Shoulder for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01) Open a PDF 7.01.125 2026-10-05 Bone & Joints (Orthopedic)
Orthopedic Joint Procedures of the Knee for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01) Open a PDF 7.01.123 2026-10-05 Bone & Joints (Orthopedic)
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members (Effective 2027-01-01) Open a PDF 7.01.121 2026-10-05 Bone & Joints (Orthopedic)
Non-Invasive Surface Electrical Stimulation for Pain and Rehabilitation Open a PDF 1.01.61 2026-05-27 Durable Medical Equipment & Supplies
Non-Invasive Prenatal Testing Open a PDF 2.02.25 2026-08-25 Lab Tests (pathology)
New/Emerging Technology and Services Code List Open a PDF 11.01.27 2026-04-30 Miscellaneous
New/Emerging Technology & Services Open a PDF 11.01.27 2025-11-25 Miscellaneous
Neuropsychological and Psychological Testing Open a PDF 3.01.24 2026-04-28 Behavioral Health (Psychiatry/Psychology)
Negative Pressure Wound Therapy (Vacuum-Assisted Closure) Open a PDF 1.01.38 2026-09-21 Skin (Dermatology)
Molecular Testing of Tumor Tissue to Identify Targeted Therapies for Cancers Open a PDF 2.02.51 2026-02-23 Genetic Disease (Inherited Disease)
Molecular Testing in the Management of Pulmonary Nodules Open a PDF 2.02.58 2025-10-22 Lab Tests (pathology)
Molecular Marker Testing of the Thyroid Open a PDF 2.02.49 2025-11-25 Genetic Disease (Inherited Disease)
Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) Open a PDF 7.01.104 2026-08-04 Urinary System (Genitourinary)
Metal-on-Metal Total Hip Resurfacing (Effective 2026-10-15) Open a PDF 7.01.74 2026-07-15 Bone & Joints (Orthopedic)
Metal-on-Metal Total Hip Resurfacing Open a PDF 7.01.74 2026-07-15 Bone & Joints (Orthopedic)
Medically Necessary Services Open a PDF 11.01.15 2025-10-22 Miscellaneous
Showing 101– 150 of 346 Results

Modal for Medical Policy and Preauthorization Information for Members of Other BlueCross Plans

Modal for Medical Policy Terms of Use

 

GDPR Notification Content