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


Brentuximab Vedotin

04/29/16 05/29/16

Genetic Testing for Epilepsy

05/04/16 06/14/16

Laser Therapy for Onychomycosis and Active Acne

05/11/16 06/11/16

Botulinum Toxin

05/16/16 06/16/16

Spinal Cord Stimulation and Peripheral Subcutaneous Field Stimulation for the Treatment of Pain

05/16/16 06/16/16

Cardioverter Defibrillators

05/16/16 06/16/16

Nonoperative Diagnostic Spinal Ultrasound (Echography/Sonogram)

05/24/16 06/24/16

Home Hyperalimentation (Total Parenteral / Enteral Nutrition)

5/25/16 06/25/15

Home Pulse Oximetry

05/25/16 06/25/16

Erythropoiesis-Stimulating Agents (ESAs)

05/27/16 06/27/16

Rotavirus Vaccine

05/27/16 06/27/16


05/27/16 06/27/16


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