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Medical Policies


9.0 Other

9.01 Miscellaneous Policies Introduction


For Blue Cross of Idaho`s definition of medically necessary and investigational, please click here. 
9.02 Dental Introduction 
9.03 Vision Introduction 
9.03.01 Keratoprosthesis
9.03.03 Orthoptic Training for the Treatment of Vision or Learning Disabilities
9.03.05 Corneal Topography/Computer-Assisted Corneal Topography/Photokeratoscopy
9.03.06 Ophthalmologic Techniques of Evaluating Glaucoma
9.03.08 Photodynamic Therapy for Choroidal Neovascularization
9.03.11 Photocoagulation of Macular Drusen
9.03.13 Retinal Telescreeing for Diabetic Retinopathy
9.03.14 Implantation of Intrastromal Corneal Ring Segments
9.03.15 Retinal Prosthesis
9.03.16 Conjunctival Incision with Posterior Juxtascleral Placement of Anecortave Acetate Depot Suspension
9.03.18 Optical Coherence Tomography (OCT) of the Anterior Eye Segment
9.03.19 Suprachoroidal Delivery of Pharmaceutical Agents
9.03.20 Intraocular Radiation Therapy for Age-Related Macular Degeneration
9.03.21 Aqueous Shunts and Stents for Glaucoma
9.03.22 Endothelial Keratoplasty 
9.03.23 Intravitreal Corticosteroid Implant
9.03.24 Intravitreal Angiogenesis Inhibitors for Choroidal Vascular Conditions
9.03.26 Viscocanalostomy and Canaloplasty 
9.03.27 Intravitreal Angiogenesis Inhibitors for Retinal Vascular Conditions 
9.03.28 Corneal Collagen Cross-Linking
9.03.29 Eyelid Thermal Pulsation for the Treatment of Dry Eye Syndrome
9.03.30 Ocriplasmin for Symptomatic Vitreomacular Adhesion
9.03.99 Fundus Photography

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