Coverage Determinations. Certain services are covered pursuant to BCBSTX medical policies and clinical procedure and coding policies, which are updated throughout the Calendar Year. The medical policies are guides considered by BCBSTX when making coverage determinations and lay out the procedure and criteria to determine whether a procedure, treatment, facility, equipment, drug or device is Medically Necessary and is an Eligible Expense or is Experimental/Investigational, cosmetic, or a convenience item. The clinical procedure and coding policies provide information about what services are reimbursable under the Plan. The most up-to-date medical and clinical procedure and coding policies are available at Amend.Ind.Legis.2022 1
Appears in 3 contracts
Sources: Preferred Provider Contract, Preferred Provider Contract, Preferred Provider Contract