Upcoming Medical Policies
BlueCross BlueShield of Tennessee

Each medical policy listed below will become effective on the date indicated, and will be included in the Medical Policy Manual for BlueCross BlueShield of Tennessee on that effective date.

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 opinions from appropriate network specialists. All Medical Policies are reviewed by a panel of internal and external physicians before being adopted by the company.

Topics due to be included in the Medical Policy Manual on 2/14/16

Topics due to be included in the Medical Policy Manual on 2/20/16

Topics due to be included in the Medical Policy Manual on 3/11/16

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Topics due to be included in the Medical Policy Manual on 2/14/2016:

Ecallantide

Filgrastim, Filgrastim-sndz and Pegfilgrastim

Magnetic Resonance Imaging (MRI) of the Breast

Topics due to be included in the Medical Policy Manual on 2/20/2016:

Carfilzomib

Elosulfase Alfa

Golimumab for Intravenous Infusion

Ramucirumab

Rituximab

Varicose Vein Treatments for the Lower Extremities

Topics due to be included in the Medical Policy Manual on 3/11/2016:

Autologous Chondrocyte Implantation

Mechanical Embolectomy for Treatment of Acute Stroke

Percutaneous Tibial Nerve Stimulation (PTNS)

Prostatic Urethral Lift


Last Review Date 1/13/2016

Medical Policy Comments:

Please reference the policy name in your comments.
To submit comments about the upcoming 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