Medical Policies

Find the medical policy you need in library below. If medical policy is not located, please refer the list of specialized services below to confirm if medical necessity review is needed.

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    Capital BlueCross defers to Centers for Medicare and Medicaid Services (CMS) guidelines for coverage positions for our Medicare Advantage (HMO and PPO) lines of business. CMS guidance takes precedence; where no Medicare guidelines exist, Capital BlueCross will defer to its existing commercial medical policy. Commercial Medical Injectable Policies do not apply.