Medical Review

Medical Policies

The medical policies listed below reflect medical criteria used/developed by Blue Cross and Blue Shield of Kansas. These medical policies do not guarantee benefits under BCBSKS member contracts.

A BCBSKS medical policy may apply to professional providers, to institutional providers or to both. That’s why the medical policy format shows separate effective dates for professional and institutional providers. It’s also why if you compare the list of professional medical policies to the list for institutional providers there could be a difference.

BCBSKS only displays the most current version of a medical policy. When updated policies become effective, prior versions are removed from this Web site.

These are the most recent policy updates.


Medical Policy Information for Out-of-Area Members

To view the out-of-area Blue Plan's medical policy information, enter the first three letters of the member's identification number on the Blue Cross Blue Shield ID card, and click "GO."

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If you experience difficulties or need additional information, please contact 800-676-BLUE.


Medical Policies

To search all medical policies by keyword or CPT code, use this search tool.

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You can also filter medical policies by the first letter of the policy title using the dropdown below.

Policy Title Date Posted Sort ascending Professional Effective Date Institutional Effective Date
Minimally Invasive Ablation Procedures for Morton and Other Peripheral Neuromas
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
Video Electroencephalogram (EEG) Monitoring
Intravenous Iron Replacement Therapy
Off-Label, Approved Orphan, and Expanded Access (Compassionate Use) Drugs
Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions
Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
Electromyography and Nerve Conduction Studies
Surgical Treatment of Snoring and Obstructive Sleep Apnea (OSA) Syndrome
Treatment of Hyperhidrosis
Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Disorders
Bronchial Thermoplasty
Cytochrome p450 Genotype-Guided Treatment Strategy
Measurement of Exhaled Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Respiratory Disorders
Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures)
Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
Implantable Cardioverter Defibrillators
Myocardial Strain Imaging
Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Treatment for Duchenne Muscular Dystrophy
Catheter Ablation as Treatment for Atrial Fibrillation
Monoclonal Antibodies for Treatment of Alzheimer Disease
Wearable Cardioverter Defibrillators
Gene Expression Profiling for Cutaneous Melanoma
Enhanced External Counterpulsation (EECP)
Extracranial Carotid Artery Stenting
Varicose Veins
Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
Intra-Articular Hyaluronan Injections for Osteoarthritis
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions
Deep Brain Stimulation
Orthopedic Applications of Platelet-Rich Plasma
Artificial Intervertebral Disc: Cervical Spine
Electrical Bone Growth Stimulation of the Appendicular Skeleton
Interspinous Fixation (Fusion) Devices
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Dry Needling of Myofascial Trigger Points
Interspinous and Interlaminar Stabilization / Distraction Devices (Spacers)
Artificial Intervertebral Disc: Lumbar Spine
Meniscal Allografts and Other Meniscus Implants
Electrical Stimulation of the Spine as an Adjunct to Spinal Fusion Procedures
Surgical Treatment of Femoroacetabular Impingement
Surgical Treatment for Gender Dysphoria
Outpatient Pulmonary Rehabilitation
Cardiac Rehabilitation in the Outpatient Setting
Photodynamic Therapy for Choroidal Neovascularization
Somatic Biomarker Testing (Including Liquid Biopsy) for Targeted Treatment and Immunotherapy in Metastatic Colorectal Cancer (KRAS, NRAF, BRAF, MMR/MSI, HER2, and TMB)
Non-invasive Positive Airway Pressure for Chronic Obstructive Pulmonary Disease (COPD)
Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease

Dental Policies

The dental policies listed below do not contain coding information. An Availity login is required to access the dental policies with full coding information. Access Availity for dental policies with full coding information here.

Archived Policies

No review or update is scheduled on these Medical Policies. If there are questions about coverage of this service, please contact Blue Cross and Blue Shield of Kansas customer service, your professional or institutional relations representative, or submit a predetermination request.