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Premera Blue Cross Medical Policy Updates – February 2023
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February 2023 Premera Blue Cross Medical Policy Updates:
- Advanced Therapies for Pharmacological Treatment of Pulmonary Arterial Hypertension
- Applied Behavior Analysis ABA
- Cardiovascular Risk Panels
- Chiropractic Services
- Clinical Trials
- Cochlear Implant
- Diagnosis and Treatment of Sacroiliac Joint Pain
- Drug Testing in Pain Management and Substance Use Disorder Treatment Settings
- Durable Medical Equipment
- Durable Medical Equipment Repair/Replacement
- Facet Joint Denervation
- Fecal Analysis in the Diagnosis of Intestinal Dysbiosis and Irritable Bowel Syndrome
- Fundus Photography
- Gender Transition/Affirmation Surgery and Related Services
- Hearing Aids (Excludes Implantable Devices)
- Herceptin® (trastuzumab) and Other HER2 Inhibitors
- Home Nutritional Support
- Hospital Beds and Accessories
- Hysterectomy for Non-Malignant Conditions
- Intracellular Micronutrient Analysis
- Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric or Substance Use Disorders
- Intravenous Iron Replacement Products
- Knee Orthoses (Braces), Ankle-Foot-Orthoses, and Knee-Ankle-Foot-Orthoses
- Laser Interstitial Thermal Therapy for Neurological Conditions
- Magnetic Esophageal Sphincter Augmentation to Treat Gastroesophageal Reflux Disease
- Measurement of Serum Antibodies to Selected Biologic Agents
- Medical Necessity Criteria for Pharmacy Edits
- Miscellaneous Oncology Drugs
- Monoclonal Antibodies for the Treatment of Lymphoma
- Multimarker Serum Testing Related to Ovarian Cancer
- Non-covered Experimental/Investigational Services
- Nonpharmacologic Treatment of Rosacea
- Nutrient/Nutritional Panel Testing
- Occupational Therapy
- Peroral Endoscopic Myotomy for Treatment of Esophageal Achalasia
- Pharmacologic Prevention and Treatment of HIV/AIDS
- Pharmacologic Treatment of High Cholesterol
- Pharmacologic Treatment of Psoriasis
- Pharmacologic Treatment of Transthyretin-Mediated Amyloidosis
- Pharmacotherapy of Arthropathies
- Pharmacotherapy of Cushing’s Disease and Acromegaly
- Pharmacotherapy of Inflammatory Bowel Disorder
- Pharmacotherapy of Miscellaneous Autoimmune Diseases
- Physical Medicine and Rehabilitation – Physical Therapy and Medical Massage Therapy
- Preventive Care
- Prolotherapy
- Proteomic Testing for Systemic Therapy in Non-Small Cell Lung Cancer
- Routine Foot Care Services
- SARS-CoV-2 Serology (Antibody) Testing
- Semi-Implantable and Fully Implantable Middle Ear Hearing Aids
- Site of Service: Infusion Drugs and Biologic Agents
- Site of Service: Infusion Drugs and Biologic Agents
- Site of Service: Select Surgical Procedures
- Skilled Home Health Care Services
- Sphenopalatine Ganglion Block for Headache
- Spravato® (esketamine) Nasal Spray
- Surgical Treatments for Lymphedema and Lipedema
- Technology Review
- Therapeutic Radiopharmaceuticals in Oncology
- Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders
- Upper Gastrointestinal (UGI) Endoscopy for Adults
- Vertebral Axial Decompression
- Wheelchairs (Manual or Motorized)
- Xolair® omalizumab
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