Draft Medical Policies
BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee works to ensure that Medical Policies are developed in an open, collaborative manner with our providers. We invite you to submit comments during the development phase of our Medical Policies.

Medical policies are developed using an evidence-based evaluation process. The medical evidence used in this process comes from several sources, including independent medical technology review organizations, the peer reviewed medical literature, and expert opinions from BCBST network specialists. We especially welcome comments that include this type of information. All Medical Policies are reviewed and approved by a panel of BCBST Medical Directors as well as board certified network physicians before final adoption by the company.

Tracking Number

Medical Policy Name

Beginning of Comment Period

End of Comment Period

DMP0415-07 Alglucosidase Alfa 04/30/15 05/3015


05/04/15 06/04/15


05/06/15 06/06/15
DMP0515-03 Genetic Testing for Marfan Syndrome, Thoracic Aortic Aneurysms and Dissections and
Related Disorders
05/08/15 06/08/15
DMP0515-04 Gender Reassignment Surgery 05/12/15 06/12/15
DMP0515-05 Mechanical Stretch Devices for the Treatment of Joint Stiffness 05/15/15 06/15/15
DMP0515-06 Home Phototherapy for Neonatal Jaundice 05/15/15 06/15/15

Human Papillomavirus (HPV) Vaccine

05/18/15 06/18/15


Medical Policy Comments:

Please reference the policy name or tracking number in your comments.
To submit comments about the draft Medical Policies:
Click the “Medical Policy Comments” above or click here: Comments or Feedback.

Comments can also be mailed to:

BlueCross BlueShield of Tennessee
Medical Policy
1 Cameron Hill Circle
Chattanooga, TN 37402