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

DMP0118-11 Ustekinumab 01/22/18 02/22/18
DMP0118-12 Golimumab IV 01/22/18 02/22/18
DMP0118-13 RimabotulinumtoxinB 01/22/18 02/22/18
DMP0118-14 Ocriplasmin 01/22/18 02/22/18
DMP0118-15 Alpha-1 01/22/18 02/22/18
DMP0118-16 Vincristine Sulfate Liposome 01/22/18 02/22/18
DMP0118-17 Triptorelin Pamoate 01/22/18 02/22/18
DMP0118-18

Diagnosis and Treatment of Sacroiliac Joint Pain

01/22/18 02/22/18
DMP0118-19

Elotuzumab

01/24/18 02/24/18
DMP0118-20

OnabotulinumtoxinA

01/24/18 02/24/18
DMP0118-21

Molecular Markers in Fine Needle Aspirates of the Thyroid

01/24/18 02/24/18
DMP0118-22

AbobotulinumtoxinA

01/24/18 02/24/18
DMP0118-23

Nelarabine

01/24/18 02/24/18
DMP0118-24

Cetuximab

01/25/18 02/25/18
DMP0218-01 Transcatheter Hepatic Arterial Chemoembolization 02/01/18 03/01/18
DMP2018-02

Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

02/01/18 03/01/18
DMP0218-03 Omacetaxine Mepesuccinate 02/05/18 03/05/18
DMP0218-04 Aldesleukin 02/07/18 03/07/18
DMP0218-05 Pralatrexate 02/07/18 03/07/18
DMP0218-06 Mepolizumab 02/07/18 03/07/18
DMP0218-07 Thyrotropin Alfa 02/07/18 03/07/18
DMP0218-08 Electromagnetic Navigation Bronchoscopy 02/09/18 03/09/18
DMP0218-09

Bariatric Surgery

02/09/18 03/09/18
DMP0218-10

Bevacizumab for the Treatment of Neoplastic Disease

02/12/18 03/12/18
DMP0218-11

Accelerated Breast Irradiation and Brachytherapy Boost after Breast-Conserving Surgery for Early-Stage Breast Cancer

02/14/18 03/14/18
DMP0218-012

Pemetrexed

02/16/18 03/16/18
DMP0218-013 Paclitaxel 02/20/18 03/20/18
DMP0218-014

Levoleucovorin

02/20/18 03/20/18

 


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