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The Medical Policies you are about to view are the property of Blue Cross Blue Shield of Nebraska (BCBSN). They have been developed by the BCBSN Medical Policy Committee (Committee) for use by BCBSN in determining the scientific validity of new and existing medical technologies, treatments, devices, drugs, etc. In developing these evidence-based Medical Policies, the Committee reviews scientific publications, including but not limited to, high quality peer-reviewed journals and periodicals. The Medical Policies are used in administering plan benefits and do not constitute medical advice. Physicians and other health care providers are responsible for providing medical advice and treatment. The Committee reviews new technologies as they emerge as well as existing Policies on a regular basis; therefore, these Policies are subject to change without notice. These Medical Policies do not constitute authorization, certification or a contract for benefits. Benefits for a particular service or item are determined by the terms and conditions of the applicable benefit contract.

These policies reference CPT codes. Current Procedural Terminology (CPT) is copyright 2003 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

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