Medical Policy

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Medical Policies

This section contains Medical Policies approved by Blue Cross and Blue Shield of Kansas City (“BCBSKC”). Medical policy determines if, and under what circumstances, medical services may be eligible for coverage. These Medical Policies describe when medical services are considered medically necessary, not medically necessary or investigational.

State and Federal mandates and health plan contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. Although a service may be medically necessary, it may be excluded under a member’s benefit plan.

The Medical Policies are regularly reviewed and may be updated or modified and, therefore, are subject to change. Benefit determinations are made in the context of Medical Policies existing at the time of the benefit determination and are not subject to later revision as the result of a change in medical policy.

The Medical Policies contained herein are for informational purposes. The Medical Policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of BCBSKC and are solely responsible for diagnosis, treatment and medical advice.

No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, photocopying, or otherwise, without permission from BCBSKC.

In addition, Current Procedural Terminology (CPT ®) codes and descriptions are the property of the American Medical Association with all rights reserved.