P F
Jul 1, 2022

Policies recently reviewed for annual update

The following policies were recently reviewed for annual update. The full texts of these policies are available in the Provider section of bcbsri.com:

  • Adult Intensive Services (AIS) and Child and Family Intensive Services (CFIT)
  • Axial Lumbosacral Interbody Fusion
  • Behavioral Health Supervisory Protocol for Licensed Clinical Social Workers and Post Doctorate Clinicians
  • Corneal Topography, Computer Assisted Corneal Topography, Photokeratoscopy
  • Cranial Orthoses (Adjustable) for Positional Plagiocephaly and Craniosynostoses         
  • Dry Needling of Trigger Point for Myofascial Pain
  • Epidural Injections for Pain Management
  • Functional Neuromuscular Electrical Stimulation
  • Intravitreal and Punctum Corticosteroid Implants
  • Nerve Graft with Radical Prostatectomy
  • Ocriplasmin for Symptomatic Vitreomacular Adhesions
  • Orthognathic Surgery
  • Out-of-Network Services Requests
  • Outpatient Pulmonary Rehabilitation
  • Patient-Controlled End of Range Motion Stretching Devices
  • Phototherapy in the Home for the Treatment of Dermatological Conditions
  • Powered Exoskeleton for Ambulation in Patients with Lower-Limb Disabilities
  • Psychological and Neuropsychological Testing
  • Prostatic Stent – Temporary
  • Reflectance Confocal Microscopy for Evaluating Skin Lesions for Suspected Malignancy.
  • Rhinomanometry and Acoustic Optical Rhinomanometry
  • Risk Reducing Mastectomy
  • Signal-Averaged Electrocardiography (SAECG)
  • Skin Contact Monochromatic Infrared Energy (MIRE)
  • Sympathetic Therapy for Pain Treatment
  • Thermal Capsulorrhaphy as a Treatment of Joint Instability
  • Thoracic Lumbosacral Orthosis with Pneumatics
  • Topographic Brain Mapping
  • Transanal Radiofrequency Treatment of Fecal Incontinence
  • Transpupillary Thermotherapy for Treatment of Choroidal Neovascularization
  • Transvaginal and Transurethral Radiofrequency Tissue Remodeling for Urinary Stress Incontinence
  • Viscocanalostomy and Canaloplasty

We also post monthly drafts of medical policies being created or reassessed for your review. As a reminder, you can provide comments on draft policies for up to 30 days. Draft policies are located on the Provider homepage, under the Medical Policies section, under the drop-down “Draft Medical Policies.”