Blue Cross of Idaho coverage policies

409 active Blue Cross of Idaho policies in Backwork, grouped by policy type. Each policy page shows the codes the policy lists and links to the payer’s own copy.

Summary of the payer’s published policy. Not a coverage determination — confirm with Blue Cross of Idaho before submitting.

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Policies

301–350 of 409, by type and title

PayerPolicy

BCIDAHO-07-01-123

Plugs for Anal Fistula Repair. no specific ICD-10-PCS code for this procedure. 0DQQ0ZZ, 0DQQ3ZZ, 0DQQ4ZZ, 0DQQ7ZZ, Surgical, repair, anus, code by approach Original Policy Date: December 2009

BCIDAHO-01-01-518

Pneumatic Compression Pumps for Treatment of Lymphedema and Venous Ulcers. Durable Medical Equipment Place of Service 1 POLICY HISTORY Date Action Description 03/25/21 Replace policy Blue Cross

BCIDAHO-01-01-528

Postsurgical Home Use of Limb Compression Devices for Venous Thromboembolism Prophylaxis. range M80.851-M80.859 Other osteoporosis with current pathological fracture, femur code range

BCIDAHO-01-03-004

Powered Exoskeleton for Ambulation in Patients With Lower-Limb Disabilities. Codes Number Description HCPCS E0739 Rehabilitation system with interactive interface providing active assistance in

BCIDAHO-05-01-500

Preferred Medical Drugs

BCIDAHO-10-01-510

Preventive Health Services. Accessed 9/12/25. 17. Women’s Preventive Services Initiative (WPSI): https://www.womenspreventivehealth.org/recommendations/ Accessed 9/12/25 POLICY HISTORY Date

BCIDAHO-02-01-026

Prolotherapy. 3E023BZ, 3E023GC, 3E023NZ, 3E023TZ Administration, introduction, muscle, percutaneous, code list – code selection depends on substance injected 3E

BCIDAHO-07-01-055

Prostate Artery Embolization for Benign Prostatic Hyperplasia. Medical Policy MP 7.01.55 Prostate Artery Embolization for Benign Prostatic Hyperplasia DISCLAIMER/INSTRUCTIONS FOR USE This