Capital Blue Cross coverage policies

223 active Capital Blue Cross 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 Capital Blue Cross before submitting.

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Policies

101–150 of 223, by type and title

PayerPolicy

CAPBLUE-MP-3.019

Inpatient Interfacility Transfers

CAPBLUE-MP-2.079

Intensive Pediatric Feeding Programs

Effective Sep 1, 2026

CAPBLUE-MP-6.047

Interferential Current Stimulation

CAPBLUE-MP-6.058

Intraocular Lenses, Spectacle Correction,and Iris Prosthesis

Effective Mar 1, 2026

CAPBLUE-MP-2.389

Intraocular Radiotherapy for Age-Related Macular Degeneration

CAPBLUE-MP-2.030

Intraoperative Neurophysiologic Monitoring (Sensory Evoked Potentials, Motor Evoked Potentials, EEG Monitoring)

CAPBLUE-MP-1.124

Intraosseous Basivertebral Nerve Ablation

Effective Jun 1, 2026

CAPBLUE-MP-2.167

Intravenous Anesthetics for the Treatment of Chronic Pain and Psychiatric Disorders

CAPBLUE-MP-4.005

Intravenous Chelation Therapy

Effective Apr 1, 2026

CAPBLUE-MP-2.159