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2.0

Medicine

2.01 Medicine Introduction 

Medically
Necessary
and
Investigational

For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 
2.01.02 Dynamic Posturography 
2.01.04 Hyperbaric Oxygen Pressurization (HBO2)  
2.01.08 Rhinomanometry and Acoustic Rhinometry 
2.01.10 Topographic Brain Mapping 
2.01.16 Recombinant and Autologous Platelet-derived Growth Factors as a Primary Treatment of Wound Healing and Other Miscellaneous Conditions 
2.01.18 Diagnosis and Medical Management of Obstructive Sleep Apnea Syndrome 
2.01.21 Temporomandibular Joint Dysfunction 
2.01.26 Prolotherapy
2.01.27 Biofeedback as a Treatment of Urinary Incontinence in Adults 
2.01.28 Neurofeedback
2.01.29 Biofeedback as a Treatment of Headache 
2.01.30 Biofeedback as a Treatment of Chronic Pain
2.01.31 Intra-articular Hyaluronan Injections for Osteoarthritis
2.01.35 Paraspinal Surface Electromyography (SEMG) to Evaluate and Monitor Back Pain
2.01.38 Transesophageal Endoscopic Therapies for Gastroesophageal Reflux Disease
2.01.39 Quantitative Sensory Testing 
2.01.40 Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions 
2.01.42 Optical Diagnostic Devices for Evaluating Skin Lesions Suspected of Malignancy
2.01.43 Chronic Intermittent Intravenous Insulin Therapy (CIIIT) 
2.01.47 Light Therapy for Psoriasis 
2.01.50 Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic Disorders 
2.01.53 Biofeedback for Miscellaneous Indications 
2.01.54 Endovascular Procedures for Intracranial Arterial Disease (Atherosclerosis and Aneurysms)
2.01.56 Low-Level Laser Therapy
2.01.57 Electrostimulation and Electromagnetic Therapy for the Treating Wounds 
2.01.58 Transanal Radiofrequency Treatment of Fecal Incontinence 
2.01.61 Measurement of Exhaled Nasal Nitric Oxide and Exhaled Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders 
2.01.64 Biofeedback as a Treatment of Fecal Incontinence or Constipation
2.01.68 Laboratory Tests for Heart Transplant Rejection
2.01.71 Non-Pharmacologic Treatment of Rosacea
2.01.73 Actigraphy
2.01.77 Automated Point-of-Care Nerve Conduction Tests 
2.01.79 Non-Contact Ultrasound Treatment for Wounds
2.01.81 Ingestible pH and Pressure Capsule
2.01.85 Neural Therapy
2.01.87 Confocal Laser Endomicroscopy
2.01.90 Navigated Transcranial Magnetic Stimulation (nTMS)
2.01.91 Peroral Endoscopic Myotomy for Treatment of Esophageal Achalsia
2.01.92 Fecal Microbiota Transplantation
2.02 Cardiology Introduction
2.02.06 Enhanced External Counterpulsation (EECP)
2.02.15 Wearable Cardioverter-Defibrillators
2.02.16 Ultrasonographic Measurement of Carotid Intimal-Medial Thickness as an Assessment of Subclinical Atherosclerosis
2.02.17 End Diastolic Pneumatic Compression Boot as a Treatment of Peripheral Vascular Disease or Lymphedema
2.02.23 Electrocardiographic Body Surface Mapping
2.02.24 Cardiac Hemodynamic Monitoring for the Management of Heart Failure in the Outpatient Setting
2.02.25 Computerized 2-lead Resting Electrocardiogram Analysis for the Diagnosis of Coronary Artery Disease
2.02.26 Percutaneous Left-Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
2.02.27 Acoustic Cardiography
2.02.28 Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy
2.02.29 Optical Coherence Tomography for Imaging of Coronary Arteries
2.03 Oncology Introduction
2.04 Pathology/Laboratory Introduction
2.04.02 Genetic Testing for Hereditary Breast and/or Ovarian Cancer
2.04.07 Urinary Tumor Markers for Bladder Cancer
2.04.08 Genetic Testing for Lynch Syndrome and Other Inherited Colon Cancer Syndromes
2.04.10 Identification of Microorganisms Using Nucleic Acid Probes
2.04.13 Genetic Testing for Familial Alzheimer’s Disease
2.04.15 Bone Turnover Markers for the Diagnosis and Management of Osteoporosis and Diseases Associated with High Bone Turnover
2.04.19 Pharmacogenomic and Metabolite Markers for Patients Treated with Thiopurines 
2.04.23 Homocysteine Testing in the Screening, Diagnosis, and Management of Cardiovascular Disease
2.04.29 Analysis of Human DNA in Stool Samples as a Technique for Cancers of Unknown Primary
2.04.32 Measurement of Lipoprotein-associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk
2.04.33 Gene-Based Tests for Screening, Detection, and/or Management of Prostate Cancer
2.04.37 Detection of Circulating Tumor Cells in the Management of Patients with Cancer
2.04.38 Cytochrome p450 Genotyping
2.04.43 Genetic Testing for Cardiac Ion Channelopathies
2.04.44 Genetic Testing for Familial Cutaneous Malignant Melanoma
2.04.45 Epidermal Growth Factor Receptor (EGFR) Mutation Analysis for Patients with Non-Small Cell Lung Cancer (NSCLC)
2.04.48 Genetic Testing for Warfarin Dose
2.04.49 Laboratory Testing for HIV Tropism
2.04.51 Genetic Testing for Tamoxifen Treatment
2.04.52 PathFinder® Molecular Testing
2.04.53 KRAS and BRAF Mutation Analysis in Metastatic Colorectal Cancer
2.04.54 Microarray-based Gene Expression Testing for Cancers of Unknown Primary
2.04.55 KRAS Mutation Analysis in Non-Small Cell Lung Cancer (NSCLC)
2.04.56 Immune Cell Function Assay
2.04.59 Genetic Testing, Including Chromosomal Microarray Analysis and Next-Generation Sequencing Panels, for Prenatal Evaluation and the Evaluation of Children With Developmental Delay/Intellectual Diability or Autism Spectrum Disorder
2.04.60 JAK2 and MPL Mutation Analysis in Myeloproliferative Neoplasms
2.04.61 Multigene Expression Assay for Predicting Recurrence in Colon Cancer
2.04.62 Protemics-based Testing Related to Ovarian Cancer
2.04.63 Use of Common Genetic Variants (single nucleotide polymorphisms) to Predict Risk of Nonfamilial Breast Cancer
2.04.66 Serum Biomarker Human Epididymis Protein 4 (HE4)
2.04.67 KIF6 Genotyping for Predicting Cardiovascular Risk and/or Effectiveness of Statin Therapy
2.04.68 Laboratory Testing for Use of 5-Flourouracil (5-FU) in Patients with Cancer
2.04.70 Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment
2.04.71 Genotyping for 9p21 Single Nucleotide Polymorphisms to Predict Risk of Cardiovascular Disease or Aneurysm
2.04.74 DNA-Based Testing for Adolescent Idiopathic Scoliosis
2.04.75 NOTCH 3 Genotyping for Diagnosis of CADASIL
2.04.76 Quantitative Assay for Measurement of HER2 Total Protein Expression and HER2 Dimers
2.04.77 BRAF Gene Mutation Testing to Select Melanoma Patients for BRAF Inhibitor Targeted Therapy
2.04.78 Molecular Markers in Fine Needle Aspirates of the Thyroid
2.04.79 Genetic Testing for Alpha-1 Antitrypsin Deficiency
2.04.80 Genetic Testing for Hereditary Hemochromatosis
2.04.81 Genetic Testing for Rett Syndrome
2.04.82 Genetic Testing for Inherited Thrombophilia
2.04.83 Genetic Testing for FMR 1 Muations (including Fragile X Syndrome)
2.04.84 Measurement of Serum Antibodies to Infliximab
2.04.85 BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
2.04.86 Genetic Testing for Duchenne and Becker Muscular Dystrophy
2.04.87 Genetic Testing for Hereditary Hearing Loss
2.04.88 Genetic Testing for PTEN Hamartoma Tumor Syndrome
2.04.89 Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies
2.04.90 Multianalyte Assays with Algorithmic Analyses for Predicting Risk of Type 2 Diabetes
2.04.91 General Approach to Genetic Testing
2.04.93 Genetic Cancer Susceptibility Panels Using Next Generation Sequencing
2.04.96 Genetic Testing for Statin-Induced Myopathy
2.04.99 Genetic Testing for Hereditary Pancreatitis
2.04.100 Cardiovascular Risk Panels
2.04.101 Genetic Testing for Li-Fraumeni Syndrome
2.04.102 Whole Exome and Whole Genome Sequencing for Diagnosis of Patients with Suspected Genetic Disorders
2.04.103 Genetic Testing for Macular Degeneration
2.04.104 Genetic Testing for Alpha Thalassemia
2.04.105 Genetic Testing for Facioscapulohumeral Muscular Dystrophy
2.04.106 Genetic Testing for CHARGE Syndrome
2.04.107 Carrier Testing for Genetic Diseases
2.04.108 Fetal RDH Genotyping Using Maternal Plasma
2.04.109 Genetic Testing for Epilepsy
2.04.110 Genecept Assay
2.04.111 Microarray-Based Gene Expression Analysis for Prostate Cancer Management
2.04.113 Analysis of MGMT Promoter Methylation in Malignant Gliomas
2.04.114 Genetic Testing for Dilated Cardiomyopathy
2.04.115 Molecular Panel Testing of Cancers to Identify Targeted Therapies
2.04.117 Genetic Testing for Mitochondrial Disorders
2.04.120 Gene Expression Profiling for Uveal Melanoma
2.04.122 Chromosomal Microarray Testing for the Evaluation of Early Pregnancy Loss
2.04.123 Serum Biomarker Panel Testing for Systemic Lupus Erythematosus
2.04.124 Genetic Testing for FLT3 and NPM1 Mutations in Acute Myeloid Leukemia
2.04.200 Drug Screen Testing
2.04.301 Salivary Hormone Testing