Medical policies are scientific documents that define the technologies, procedures and treatments that are considered investigational, medically necessary and not medically necessary. Medical policy statements contain conclusions about whether a technology, procedure, treatment, supply, equipment, drug or other service improves health outcomes for the health plan's population and therefore is covered or not covered.
Finding a Medical Policy
Medical and Pharmacy Policy Updates
To make it easier for providers to find the new policies and revisions that are of interest to them, the Medical Policy Administration and Pharmacy Administration departments have developed a searchable list of new, revised and clarified policies and summary tables. Please click on the updates that you want to review.
Medical Policy Updates for January 2019POSTED: October 1, 2018
Medical Policy Updates for December 2018POSTED: September 1, 2018
Medical Policy Updates for November 2018POSTED: August 1, 2018
Medical Policy Updates for October 2018POSTED: July 1, 2018
Medical Policy Updates for September 2018POSTED: June 1, 2018
Medical Policy Updates for August 2018POSTED: May 1, 2018
To request draft policies:
Ordering Providers: A full draft version of each policy is available only by request to ordering participating clinician providers one month prior to the effective date of the policy. To request draft policies, send an e-mail to Medical Policy Administration mailbox below.
Medical Policy Group Meeting Information
-The medical policy group meeting is a forum for in network providers to discuss medical policy topics.
-Network providers who plan to attend the meeting must confirm and provide their contact information by email to Medical Policy Administration mailbox below at least 48 hours before the meeting.
All meetings take place at BCBSMA, 101 Huntington Avenue, Boston, MA.
Network physicians who plan to attend the meeting must confirm and provide their contact information by email to Medical Policy Administration mailbox below at least 48 hours before the meeting. It is important that Blue Cross Blue Shield have the contact information for any physician who will be attending this meeting, since we need to mail confidentiality and conflict-of-interest forms. Attending physicians may either take part in the meeting in person or via conference call. If a physician would like to call in to the meeting, a conference number will be provided by BCBSMA prior to the meeting date. Note: Please be aware that this meeting may end early if there are no attending providers.
The Medical Policy Administration mailbox is only for comments and recommendations of participating ordering providers on medical policies. The Medical Policy Administration mailbox cannot address questions regarding benefits, claims, billing, payment, reimbursement, appeals, individual case exception review, advance determination, prior authorization, or reconsideration review.
Medical Policy Site Disclaimer
Each document on this site is provided for informational purposes only and is not an authorization, explanation of benefits, or contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.