| Oct 2, 2026 | BlueCross BlueShield of Tennessee | AcupuncturePayerPolicy · BCBSTN-a00c540d36 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | ActigraphyPayerPolicy · BCBSTN-81b2fc03bc | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Corticotropin-ACTH: [HP Acthar Gel (repository corticotropin injection), Cortrophin GelPayerPolicy · BCBSTN-3317627ff4 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Tocilizumab (Actemra); Tocilizumab-anoh (Avtozma); Tocilizumab-bavi (Tofidence); Tocilizumab-aazg (Tyenne)PayerPolicy · BCBSTN-78d84e19bb | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Rhinomanometry and Acoustic RhinometryPayerPolicy · BCBSTN-b7aa301b68 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Balloon and Self-Expanding Absorptive Ostial Dilation for Treatment of RhinosinusitisPayerPolicy · BCBSTN-80bd4cf30b | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Absorbable Nasal Implant for the Treatment of Nasal Valve CollapsePayerPolicy · BCBSTN-f8ec52622b | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Paclitaxel (Albumin-Bound) (Abraxane; Paclitaxel Albumin-Bound)PayerPolicy · BCBSTN-2a7cc49102 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | AbobotulinumtoxinA (Dysport)PayerPolicy · BCBSTN-7bfedb9e3c | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Ablation Procedure for Peripheral NeuromasPayerPolicy · BCBSTN-982dbdab45 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Radiofrequency Ablation for Nasal Obstruction and RhinitisPayerPolicy · BCBSTN-a66057c6aa | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Idecabtagene Vicleucel (Abecma)PayerPolicy · BCBSTN-cadae45332 | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Abbreviated Daytime Sleep Study (e.g. PAP-NAP)PayerPolicy · BCBSTN-07e665322d | Metadata changed |
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| Oct 2, 2026 | BlueCross BlueShield of Tennessee | Abatacept (Orencia)PayerPolicy · BCBSTN-f7a10b5737 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Leqvio (inclisiran). Medical Policy MP 5.01.663 Leqvio (inclisiran) DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross of Idaho benefit plansPayerPolicy · BCIDAHO-05-01-663-FUTURE | Retired |
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| Oct 2, 2026 | Blue Cross of Idaho | Pharmacologic Compounds. Benefit Exceptions This policy may not apply to all lines of business such as the Federal Employee Program, Medicare Supplement, Medicare Advantage, Medicaid, andPayerPolicy · BCIDAHO-05-01-650-FUTURE | Retired |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Thalassemia. Approach, New Technology Group 8 Type of Service Drugs/Biologics Place of Service Inpatient/Outpatient POLICY HISTORY Date Action Description 12/29/22 New polPayerPolicy · BCIDAHO-05-01-042-FUTURE | Retired |
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| Oct 2, 2026 | Blue Cross of Idaho | Preventive Health Services Appendix 1. Pregnancy Diagnosis CodesPayerPolicy · BCIDAHO-10-01-510-APPENDIX1 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Hematopoietic Cell Transplantation for Primary AmyloidosisPayerPolicy · BCIDAHO-08-01-042 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Sickle Cell DiseasePayerPolicy · BCIDAHO-05-01-048 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Parenteral, Enteral and Oral Nutrition in the HomePayerPolicy · BCIDAHO-01-02-501 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Metachromatic LeukodystrophyPayerPolicy · BCIDAHO-05-01-051 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Intravenous Antibiotic Therapy and Associated Diagnostic Testing for Lyme DiseasePayerPolicy · BCIDAHO-05-01-008 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Therapeutic Radiopharmaceuticals for Prostate CancerPayerPolicy · BCIDAHO-05-01-043 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Dopamine Transporter Imaging With Single-Photon Emission Computed TomographyPayerPolicy · BCIDAHO-06-01-054 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Suture Button Suspensionplasty Fixation System for Thumb Carpometacarpal OsteoarthritisPayerPolicy · BCIDAHO-07-01-176 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Lumasiran for Primary Hyperoxaluria Type 1PayerPolicy · BCIDAHO-05-01-037 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Givosiran for Acute Hepatic PorphyriaPayerPolicy · BCIDAHO-05-01-040 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Outpatient Speech TherapyPayerPolicy · BCIDAHO-08-03-503 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Duchenne Muscular DystrophyPayerPolicy · BCIDAHO-05-01-046 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Cerebral AdrenoleukodystrophyPayerPolicy · BCIDAHO-05-01-545 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Intravenous Ustekinumab for Inflammatory Bowel DiseasePayerPolicy · BCIDAHO-05-01-664 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Intravenous InfliximabPayerPolicy · BCIDAHO-05-01-668 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Subcutaneous Continuous Infusion Pharmacologic Treatment of Parkinson’s DiseasePayerPolicy · BCIDAHO-05-01-669 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Orencia (abatacept) for Intravenous UsePayerPolicy · BCIDAHO-05-01-671 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Low-Dose Radiotherapy for Non-Oncologic IndicationsPayerPolicy · BCIDAHO-07-01-179 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Percutaneous Revascularization Procedures for Lower Extremity Peripheral Arterial DiseasePayerPolicy · BCIDAHO-07-01-178 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Axillary Reverse Mapping for Prevention of Breast Cancer-Related LymphedemaPayerPolicy · BCIDAHO-07-01-173 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Intracellular Micronutrient AnalysisPayerPolicy · BCIDAHO-02-04-073 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Treatment of Hereditary Transthyretin-Mediated Amyloidosis in Adult PatientsPayerPolicy · BCIDAHO-05-01-530 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | General Coverage GuidelinesPayerPolicy · BCIDAHO-09-01-501 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Continuous Glucose MonitoringPayerPolicy · BCIDAHO-01-01-020 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gazyva (obinutuzumab) for Non-oncologic UsesPayerPolicy · BCIDAHO-05-01-673 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Gene Therapies for Treatment of Wounds in Dystrophic Epidermolysis BullosaPayerPolicy · BCIDAHO-05-01-047 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Botulinum ToxinPayerPolicy · BCIDAHO-05-01-505 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | High-Dose Rate Temporary Prostate BrachytherapyPayerPolicy · BCIDAHO-08-01-033 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Rituximab For Nononcologic UsesPayerPolicy · BCIDAHO-05-01-672 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Automated Insulin Delivery SystemsPayerPolicy · BCIDAHO-01-01-530 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Prostate Artery Embolization for Benign Prostatic HyperplasiaPayerPolicy · BCIDAHO-07-01-055 | Metadata changed |
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| Oct 2, 2026 | Blue Cross of Idaho | Intracoronary Drug Delivery Balloon ProceduresPayerPolicy · BCIDAHO-07-01-097 | Metadata changed |
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