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Coverage Policy


What You Will See

When you select a policy, you will see its title, category and effective date at the top of the page. A description of the treatment and the actual policy, which explains what is covered, follow. At the bottom of the page, you will see related CPT codes and references.

Important Notice For BlueAdvantage Administrators of Arkansas Groups:

The existence of an affirmative Coverage Policy does not certify coverage, nor does it override or replace specific coverage language listed in an individual policy or group health plan. While a procedure, technology or drug may be medically necessary, it still may be specifically excluded under the terms of a member's contract or benefit plan, or the use may be an investigational or experimental use of the service and therefore excluded under the experimental or investigational language of the member's benefit contract or plan. The absence of a specific Coverage Policy does not indicate that a service is covered. For example, a new device or a new use of an old device may not have been proven safe and effective, but coverage may also have not been previously requested, thereby providing us an opportunity to study the information on the safety and effectiveness of the new use of the device.

(Specific to Discrete Procedures or Technologies)

The medical director of Arkansas Blue Cross and Blue Shield has established specific coverage policies addressing certain medical procedures or technologies.

The purpose of a Coverage Policy is to inform members and their physicians why certain medical procedures may or may not be covered under Arkansas Blue Cross and Blue Shield health plans. In addition to these specific Coverage Policies, all Arkansas Blue Cross and Blue Shield health plans or contracts also include more generally applicable coverage standards known or the Primary Coverage Criteria. The Primary Coverage Criteria apply to ALL benefits members may claim under their plan, no matter what types of health intervention may be involved or when or where members obtain the intervention. For more specifics on Primary Coverage Criteria, click on the Primary Coverage Criteria link below.