Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Recorded changes
82,180 on record
Recorded policy changes, newest first| Recorded | Payer | Policy | Change |
|---|
| Sep 30, 2026 | Blue Cross NC | Medicare Advantage Coverage Determination HierarchyPayerPolicy · BCBSNC-MEDICARE-ADVANTAGE-COVERAGE-DETERMINATION-HIERARCHY-D6C38BCF5B | Retired |
|---|
| Sep 30, 2026 | Blue Cross NC | Viscocanalostomy and CanaloplastyPayerPolicy · BCBSNC-VISCOCANALOSTOMY-AND-CANALOPLASTY-E163F217F1 | Retired |
|---|
| Sep 30, 2026 | Blue Cross NC | Viscocanalostomy and CanaloplastyPayerPolicy · BCBSNC-VISCOCANALOSTOMY-AND-CANALOPLASTY-312D794DDA | New policy |
|---|
| Sep 30, 2026 | Blue Cross NC | Micronutrient Testing AHS – G2099PayerPolicy · BCBSNC-MICRONUTRIENT-TESTING-AHS-G2099-10873BADDE | New policy |
|---|
| Sep 30, 2026 | Blue Cross NC | Colorectal Cancer Screening AHS - G2181PayerPolicy · BCBSNC-COLORECTAL-CANCER-SCREENING-AHS-G2181-0F98DE6605 | New policy |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Gene Therapies for Metachromatic Leukodystrophy. Medical Policy MP 5.01.49 Gene Therapies for Metachromatic Leukodystrophy DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-05-01-049-89C761038E | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | High Intensity Laser Therapy for Chronic Musculoskeletal Pain Conditions and Bell's Palsy. Medical Policy MP 2.01.108 High Intensity Laser Therapy for Chronic Musculoskeletal Pain ConditionsPayerPolicy · BCIDAHO-02-01-108-91C1EE4667 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Uterus Transplantation for Absolute Uterine Factor Infertility. Medical Policy MP 4.02.06 Uterus Transplantation for Absolute Uterine Factor Infertility DISCLAIMER/INSTRUCTIONS FOR USE ThisPayerPolicy · BCIDAHO-04-02-006-E1C49168A5 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial Fibrillation. Medical Policy MP 7.01.172 Surgical Left Atrial Appendage Occlusion Devices for Stroke PreventionPayerPolicy · BCIDAHO-07-01-172-B6BDA06182 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Urinary Test for Renal Allograft Rejection. Medical Policy MP 7.03.15 Urinary Test for Renal Allograft Rejection DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidancePayerPolicy · BCIDAHO-07-03-015-AFBFB53F63 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver Tumors. Medical Policy MP 7.01.95 Radiofrequency Ablation of Miscellaneous Solid Tumors Excluding Liver TumorsPayerPolicy · BCIDAHO-07-01-095-898C1304CA | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Electrical Stimulation Devices. Medical Policy MP 1.01.507 Electrical Stimulation Devices for Pain Control DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance forPayerPolicy · BCIDAHO-01-01-507-4C32EF7A98 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Liposuction for Lipedema and Lymphedema. Medical Policy MP 7.01.169 Liposuction for Lipedema and Lymphedema DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance forPayerPolicy · BCIDAHO-07-01-169-CDB2E6CD39 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Baroreflex Stimulation Devices. Medical Policy MP 8.01.57 Baroreflex Stimulation Devices DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross ofPayerPolicy · BCIDAHO-08-01-057-D906EBCE86 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Biological Treatments for Refractory Myasthenia Gravis. Medical Policy MP 5.01.539 Biological Treatments for Refractory Myasthenia Gravis DISCLAIMER/INSTRUCTIONS FOR USE This medical policyPayerPolicy · BCIDAHO-05-01-539-118DF1E48F | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Remote Electrical Neuromodulation for Migraines. Medical Policy MP 7.01.171 Remote Electrical Neuromodulation for Migraines DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-07-01-171-B63D9A4342 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Renal Denervation for Uncontrolled Hypertension. Medical Policy MP 7.01.136 Renal Denervation for Uncontrolled Hypertension DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-07-01-136-0E16ECE116 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Simponi Aria (Golimumab) for Intravenous Use. Medical Policy MP 5.01.670 Simponi Aria (golimumab) for Intravenous Use DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-05-01-670-67638B3210 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Krystexxa. Medical Policy 5.01.665 Krystexxa DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross of Idaho benefit plans (for purposes of thisPayerPolicy · BCIDAHO-05-01-665-43DEAED803 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Amniotic Membrane and Amniotic Fluid. Medical Policy MP 7.01.149 Amniotic Membrane and Amniotic Fluid DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applyingPayerPolicy · BCIDAHO-07-01-149-E6B9FAD9E0 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Transurethral Water Vapor Thermal Therapy and Transurethral Water Jet Ablation for Benign Prostatic Hyperplasia. Medical Policy MP 2.01.549 Transurethral Water Vapor Thermal Therapy andPayerPolicy · BCIDAHO-02-01-549-F08A928B61 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Treatment of Nasal Valve Collapse and Nasal Septal Swell Bodies. Medical Policy MP 7.01.663 Treatment of Nasal Valve Collapse and Nasal Septal Swell Bodies DISCLAIMER/INSTRUCTIONS FOR USE ThisPayerPolicy · BCIDAHO-07-01-663-559784E9CC | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Immersive Virtual Reality Therapy for Chronic Lower Back Pain. Medical Policy MP 3.03.06 Immersive Virtual Reality Therapy for Chronic Lower Back Pain DISCLAIMER/INSTRUCTIONS FOR USE ThisPayerPolicy · BCIDAHO-03-03-006-1AA26CC0C6 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Immersive Virtual Reality Therapy for Chronic Lower Back Pain. Medical Policy MP 3.03.07 Audio-Visual Neuromodulation for Neuropathic Pain DISCLAIMER/INSTRUCTIONS FOR USE This medical policyPayerPolicy · BCIDAHO-03-03-007-DD04A7A0C5 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Yartemlea (narsoplimab-wuug). Medical Policy MP 5.01.677 Yartemlea (narsoplimab-wuug) DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross ofPayerPolicy · BCIDAHO-05-01-677-908C17A2C2 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Exdensur (depemokimab-ulaa). Medical Policy MP 5.01.678 Exdensur (depemokimab-ulaa) DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross ofPayerPolicy · BCIDAHO-05-01-678-5E1913065A | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Implantable Shock Absorbers for Treatment of Knee Osteoarthritis. Medical Policy MP 7.01.90 Implantable Shock Absorbers for Treatment of Knee Osteoarthritis DISCLAIMER/INSTRUCTIONS FOR USE ThisPayerPolicy · BCIDAHO-07-01-090-D27FCD966A | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Entyvio (vedolizumab) for Inflammatory Bowel Disease. Medical Policy MP 5.01.662 Entyvio (vedolizumab) for Inflammatory Bowel Disease DISCLAIMER/INSTRUCTIONS FOR USE This medical policyPayerPolicy · BCIDAHO-05-01-662-39A3C47F51 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Entyvio (vedolizumab) for Inflammatory Bowel Disease. Medical Policy MP 5.01.662 Entyvio (vedolizumab) for Inflammatory Bowel Disease DISCLAIMER/INSTRUCTIONS FOR USE This medical policyPayerPolicy · BCIDAHO-05-01-662-CAC5D15BB8 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Evaluation of Biomarkers for Alzheimer Disease. Medical Policy MP 2.04.514 Evaluation of Biomarkers for Alzheimer Disease DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-02-04-514-E73E46107C | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Evaluation of Biomarkers for Alzheimer Disease. Medical Policy MP 2.04.514 Evaluation of Cerebrospinal Fluid, Urine and Plasma for Alzheimer Disease DISCLAIMER/INSTRUCTIONS FOR USE This medicalPayerPolicy · BCIDAHO-02-04-514-981F75DF14 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Hematopoietic Cell Transplantation for Autoimmune Diseases. Medical Policy MP 8.01.25 Hematopoietic Cell Transplantation for Autoimmune Diseases DISCLAIMER/INSTRUCTIONS FOR USE This medicalPayerPolicy · BCIDAHO-08-01-025-E20B8F98E2 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Bariatric Surgery. Type of service Surgery Place of service Inpatient POLICY HISTORY Date Action Description 02/25/21 Replace policy Blue Cross of Idaho adopted changes as noted, effectivePayerPolicy · BCIDAHO-07-01-547-4E2576F96A | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver MalignanciesPayerPolicy · BCIDAHO-08-01-011-1714FD931B | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Percutaneous Electrical Nerve Field Stimulation for Irritable Bowel SyndromePayerPolicy · BCIDAHO-02-01-106-AC47C17EAB | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Medicare Part B Medical Drugs Step Therapy. Medical Policy MP 5.01.610 Medicare Advantage Part B Medical Drugs Step Therapy DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-05-01-610-A8833CA763 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone. Type of Service Surgery Place of Service Outpatient/Inpatient POLICY HISTORY Date Action Description 07/27/20PayerPolicy · BCIDAHO-07-01-092-AAF3171DFD | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Dopamine Transporter Imaging With Single-Photon Emission Computed Tomography. G31.83 Neurocognitive disorder with Lewy bodies ICD10-PCS ICD-10-PCS codes are only used for inpatient services.PayerPolicy · BCIDAHO-06-01-054-035150099B | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Outpatient Speech Therapy. MP 8.03.503 Outpatient Speech Therapy (ST) 92615 Interpretation and report only 92616 Flexible endoscopic evaluation of swallowing and laryngeal sensory testing byPayerPolicy · BCIDAHO-08-03-503-C5E232531B | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Testing and Treatment for Recurrent Pregnancy Loss. 86828, 86829 Antibody to human leukocyte antigens (HLA), solid phase assays (e.g., microspheres or beads, ELISA, flow cytometry); qualitativePayerPolicy · BCIDAHO-04-02-510-C6A2C0AF75 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Selected Positron Emission Tomography Technologies for Evaluation of Alzheimer DiseasePayerPolicy · BCIDAHO-06-01-555-846C2CE0F5 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Synthetic Cartilage Implants for Joint PainPayerPolicy · BCIDAHO-07-01-160-D9A961CF75 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Medical Drugs Not Eligible for Reimbursement. Medical Policy MP 5.01.502 Medical Drugs Not Eligible for Reimbursement DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-05-01-502-0189625F18 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Medical Drugs Not Eligible for Reimbursement. Medical Policy MP 5.01.502 Medical Drugs Not Eligible for Reimbursement DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides generalPayerPolicy · BCIDAHO-05-01-502-5AA3DCC42F | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Noninvasive Techniques for the Evaluation and Monitoring of Patients With Chronic Liver Disease. references addedPayerPolicy · BCIDAHO-02-04-041-2B30D19C11 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Medical Cannabis. alternative medicine in multiple sclerosis: report of the guideline development subcommittee of the American Academy of Neurology. Neurology. Mar 25 2014; 82(12): 1083-92. PMIDPayerPolicy · BCIDAHO-05-01-532-182186CA68 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Permanently Implanted Prostatic Devices for Benign Prostatic HyperplasiaPayerPolicy · BCIDAHO-07-01-181-5618B267FE | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Maternal Serum Biomarkers for Prediction of Adverse Obstetric Outcomes. Codes Number Description CPT 0243U Obstetrics (preeclampsia), biochemical assay of placental-growth factor, timeresolvedPayerPolicy · BCIDAHO-02-04-152-90913D1AD5 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Ambulance and Medical Transport Services. Medical Policy DISCLAIMER/INSTRUCTIONS FOR USE Medical policy provides general guidance for applying Blue Cross of Idaho benefit plans (for purposes ofPayerPolicy · BCIDAHO-02-01-555-D1EBA20409 | Retired |
|---|
| Sep 30, 2026 | Blue Cross of Idaho | Computed Tomography to Detect Coronary Artery Calcification. Medical Policy Medical Policy MP 6.01.03 Computed Tomography to Detect Coronary Artery Calcification DISCLAIMER/INSTRUCTIONS FOR USE ThisPayerPolicy · BCIDAHO-06-01-003-E9B42C9881 | Retired |
|---|