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Final Medical Policies

Our draft medical policies and final medical policies are displayed on this site. Medical policies are based on the most current medical research available at the time of the policy development.

Policies are written to cover a given condition for the majority of people. Each individual's unique clinical circumstances may be considered in light of current scientific literature. Medical policies are based on constantly changing medical science and the Plan reserves the right to review and update our policies as necessary.

We encourage practicing physicians to provide input related to developing, adopting and reviewing criteria for medical policy. Any licensed practitioner is welcome to provide comments, suggestions or concerns. Our internal policy committee will review and take your comments into consideration. For medical policy feedback, email comments to

Note: Coverage is subject to the member's specific benefits. Group-specific benefits will supersede these policies when applicable. Always check eligibility and benefits through your local Blue Plan provider portal or your practice management system to confirm member-specific benefits. 

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Medical Policies by Category

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Durable Medical Equipment (DME)