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

201–223 of 223, by type and title

PayerPolicy

CAPBLUE-MP-1.164

Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia

CAPBLUE-MP-2.062

Temporomandibular Disorder

CAPBLUE-MP-6.061

Therapeutic Shoes for Persons with Diabetes

CAPBLUE-MP-1.086

Thermal Capsulorrhaphy as a Treatment of Joint Instability

CAPBLUE-MP-5.017

Thermography

CAPBLUE-MP-6.046

Threshold Electrical Stimulation as a Treatment of Motor Disorders

Effective Feb 1, 2026

CAPBLUE-MP-1.134

Tibial Nerve Stimulation

CAPBLUE-MP-6.020

Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation

Effective Apr 1, 2026

CAPBLUE-MP-2.053

Transesophageal Endoscopic Therapies For Gastroesophageal Reflux Disease (Formerly Procedures For The Treatment Of Gastroesophageal Reflux Disease)

CAPBLUE-MP-4.053

Capital Blue Cross coverage policies

Policies

PayerPolicy

Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia

Temporomandibular Disorder

Therapeutic Shoes for Persons with Diabetes

Thermal Capsulorrhaphy as a Treatment of Joint Instability

Thermography

Threshold Electrical Stimulation as a Treatment of Motor Disorders

Tibial Nerve Stimulation

Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation

Transesophageal Endoscopic Therapies For Gastroesophageal Reflux Disease (Formerly Procedures For The Treatment Of Gastroesophageal Reflux Disease)

Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy

Capital Blue Cross coverage policies

Policies

PayerPolicy

Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic Hyperplasia

Temporomandibular Disorder

Therapeutic Shoes for Persons with Diabetes

Thermal Capsulorrhaphy as a Treatment of Joint Instability

Thermography

Threshold Electrical Stimulation as a Treatment of Motor Disorders

Tibial Nerve Stimulation

Transcutaneous Electrical Nerve Stimulation and Transcutaneous Afferent Patterned Stimulation

Transesophageal Endoscopic Therapies For Gastroesophageal Reflux Disease (Formerly Procedures For The Treatment Of Gastroesophageal Reflux Disease)

Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation (Aquablation) for Benign Prostatic Hypertrophy

Treatment of Dry Eye Syndrome

Treatment of Varicose Veins - Venous Insufficiency

Trigger Point and Tender Point Injections

Tumor Treating Fields Therapy

Upper Limb Prostheses

Vagus Nerve and Implantable Peripheral Nerve Stimulators

Vertebral Axial Decompression

Vertebral Fracture Assessment and Biochemical Computed Tomography (Formerly Vertebral Fracture Assessment and Trabecular Bone Score)

Vertical Expandable Prosthetic Titanium Rib

Vision Therapy

Whole Body Dual X-Ray Absorptiometry to Determine Body Composition

Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders

Wound and Burn Management and Specialized Treatment Centers