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 Professional Effective Date Sort descending Institutional Effective Date
Coronary Computed Tomography Angiography with Selective Noninvasive Fractional Flow Reserve
Fundus Photography
Catheter Ablation as Treatment for Atrial Fibrillation
Molecular Markers in Fine Needle Aspiration of the Thyroid
Meniscal Allografts and Other Meniscus Implants
Adjustable Cranial Orthoses for Positional Plagiocephaly and Craniosynostoses
Surgical Treatment of Snoring and Obstructive Sleep Apnea (OSA) Syndrome
Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy
Varicose Veins
Cryoablation of Tumors Located in the Kidney, Lung, Breast, Pancreas, or Bone
Autologous Chondrocyte Implantation for Focal Articular Cartilage Lesions
Myocardial Strain Imaging
Virtual Colonoscopy / CT Colonography
Microprocessor-Controlled Prostheses for the Lower Limb
Myoelectric Prosthetic Components for the Upper Limb
Microwave Tumor Ablation
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
General Approach to Genetic Testing
Electromyography and Nerve Conduction Studies
Treatment of Hyperhidrosis
Measurement of Serum Antibodies to Selected Biologic Agents
Endoscopic Radiofrequency Ablation or Cryoablation for Barrett Esophagus
Genetic Testing for Cardiac Ion Channelopathies
Stereotactic Radiosurgery and Stereotactic Body Radiotherapy
Gastric Electrical Stimulation
Proteomic Testing for Systemic Therapy in Non-Small-Cell Lung Cancer
Low Intensity Pulsed Ultrasound Fracture Healing Device
Molecular Testing for the Management of Pancreatic Cysts, Barrett’s Esophagus, and Solid Pancreaticobiliary Lesions
Cochlear Implant
Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections, and Related Disorders
Implantable Bone-Conduction and Bone-Anchored Hearing Aids
Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
Drug Testing in Pain Management and Substance Use Disorder Treatment
Surgical Deactivation of Headache Trigger Sites
Transcatheter Arterial Chemoembolization (TACE) to Treat Primary or Metastatic Liver Malignancies
Sacral Nerve Neuromodulation / Stimulation
Hydrogel Spacer use During Radiotherapy for Prostate Cancer
Optical Coherence Tomography (OCT) of the Anterior Eye Segment
Balloon Dilation of the Eustachian Tube
Video Electroencephalogram (EEG) Monitoring
Continuous Passive Motion in the Home Setting
Treatment for Duchenne Muscular Dystrophy
Aqueous Shunts and Stents for Glaucoma
Amniotic Membrane and Amniotic Fluid
Implantable Cardioverter Defibrillators
Extracranial Carotid Artery Stenting
Screening for Lung Cancer Using CT Scanning
Analysis of Human DNA in Stool Samples as a Technique for Colorectal Cancer Screening
Breast Reconstructive Surgery After Mastectomy
Injectable Bulking Agents for the Treatment of Urinary and Fecal Incontinence

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.