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Medical Policies
Our medical policies do not constitute medical advice. Treating practitioners are entirely responsible for medical advice and for the treatment of their patients. As a result, we recommend that you review these policies with your doctor to fully understand how a policy relates to your particular situation. Learn more about how policies are developed.

Intention for Use:
Medical policies do not constitute medical advice. Treating practitioners are entirely responsible for medical advice and for the treatment of their patients. Medical policies are based upon a review of scientific-based evidence used to determine the scientific merit of a particular medical technology or technologies. Medical Policies can be highly technical and are designed to be used by health care practitioners when caring for our members. As a result we recommend you review these policies with your doctor to fully understand how a policy relates to your particular situation.

Medical services are constantly changing and we periodically review and update our medical policies. Although we try to maintain up-to-date medical policies online, some recent changes may not yet be included. Our most recent policies shall apply.

Medical policies guide decisions about coverage. They are statements about a particular technology or are a blend of administrative and medical appropriateness information that helps clarify coverage of services based on interpretation of member/subscriber contracts. Coverage depends on your individual contract and the medical necessity of the procedure relating to your individual situation.

These policies apply to patients with commercial contracts only. Medicare policies will be followed for patients with Medicare contracts.

Select a Category to View Policies or View Policies for Members of Other BlueCross Plans.
In accessing our Medical Policies you signify your agreement to our Terms of Use.

Comment On Our Policies - To ensure that the development of our medical policies occurs
through an open and collaborative process, we invite practitioners to review and comment on
our policies.

Learn More about Medical Policies - Learn How Medical Policies are Developed (PDF)
and about Experimental & Investigational Procedures.

Our Medical Policies contain Physician Current Procedural Terminology ("CPT"), a coding work of nomenclature and five-digit codes for reporting of physician services. CPT is protected by copyright and trademark owned by the American Medical Association ("AMA").

In order to view the item containing CPT you agree:

  1. AMA is the owner of all copyright, trademark and other rights to CPT and its updates. AMA reserves all such rights. No fee schedules, basic units, relative values or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein.
  2. CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, implied warranties of merchantability and fitness for a particular use. AMA, Excellus BlueCross BlueShield and its affiliates disclaim any responsibility for any consequences or liability attributable to or related to any use, non-use or interpretation of the information containing CPT.
  3. Use of CPT by you, your employees, agents and assigns is limited to matters in connection with submitting claims to Excellus BlueCross BlueShield and its affiliates, and only within the United States of America and its territories.
  4. Any use of CPT not authorized herein in prohibited, including by way of illustration and not by way of limitation, making copies of CPT for sale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, making any commercial use of CPT, or placing CPT or information contained therein in any public electronic bulletin board or public computer based information system (including the Internet and World Wide Web).
  5. Applicable FARS/DFARS Restrictions apply to Government Use.
  6. You may make copies of CPT for backup or archival purposes only. Such backup or archival copy must bear notice of the AMA copyright, trademark and proprietary rights to CPT.
  7. You must take necessary and appropriate action to assure that you, your employees, agents and assigns comply with the terms of this agreement.
  8. This license shall terminate without notice if you violate its terms.

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