Self-Administered Drug Prior Authorization Forms
Drug policies are based on:
information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by...
Final Self-Administered Drug Policies
Drug policies are based on:
information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the FDA, as...
Voluntary Site of Service
The Voluntary Site of Service policy is part of the Provider-Administered Drug Review Program. The primary objective of the Voluntary Site of Service program is...
Mandatory Site of Service Policy
The Mandatory Site of Service policy is part of the Provider-Administered Drug Review Program. The primary objective of Mandatory Site of Service is to guide the...
Pharmacy policies should be added here.
Medical policies should be added here.
Provider-Administered Drug Claim Edit Policies
For the provider-administered drugs linked below, claims submitted to the plan must include an appropriate diagnosis code within the drug’s policy...
Final Provider-Administered Precertification Drug Policies
Provider-Administered drugs require that a member’s medical condition meets the policy requirements prior to being given...
Final Hemophilia Drug Precertification Policies
Drug policies are based on:
information in FDA-approved package inserts (and black box warnings, alerts or other information disseminated by the...
Hemophilia Drugs
To contribute to improved transparency around clinical management, Prime Therapeutics Hemophilia Management services will be used to perform utilization management and...
The following preventive services and immunizations do not apply to all health plans administered or insured by your Blue Plan. Some or all of the
contraceptive Methods or...
PREVENTIVE CARE SERVICES
The following is a list of preventive services (HCP rider) along with the diagnoses and procedure codes that your health plan has determined to meet and in some...
CPT codes, descriptions and data copyright © BCBSPREVIOUSYEAR American Medical Association. All rights reserved. Applicable FARS/DFARS apply.
CDT codes, descriptions and data copyright...
Transgender Services Benefits
On May 18, 2016, the Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS) published its final regulation implementing Section 1557 of...
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