Excellus BCBS

  • Handicapped Dependent Coverage (PDF) Policy 10.01.08 (posted 7/29/14)
  • Experimental or Investigational Services (PDF) Policy 11.01.03 (posted 3/17/14)
  • Emergency Care Services (PDF) Policy 10.01.12 (posted 5/13/14)
  • Disability Determination for Extension of Benefits after Contract Termination (PDF) Policy 10.01.11 (posted 7/29/14)
  • Dental Inlays and Onlays (PDF) Policy 13.01.03 (posted 5/13/14)
  • Dental Implants (PDF) Policy 13.01.01 (posted 5/13/14)
  • Dental Crowns and Veneers (PDF) Policy 13.01.02 (posted 5/13/14)
  • Comfort, Convenience, Custodial or Cosmetic Services (PDF) Policy 11.01.11 (posted 1/8/14)
  • Clinical Trials (PDF) Policy 11.01.10 (posted 1/8/14)
  • Dental and Oral Care under Medical Plans: Bone Cysts, Odontogenic Cysts, Oral Surgery (PDF) Policy 7.01.21 (Posted 7/29/14)
  • Ambulance: Land/Ground (PDF) Policy 10.01.07 (posted 5/12/14)
  • Ambulance: Air (PDF) Policy 11.01.06 (posted 5/12/14)
  • Surgical Management of Sleep Disorders/Sleep Apnea: Cautery-Assisted Palatal Stiffening (CAPSO), Genioglossal Advancement, MMA, Palatal Implant Pillar System, PLAUP, Repose, Snoreplasty, Somnoplasty, UPPP (PDF) Policy 7.01.41 (posted 3/26/14)
  • Sleep Studies: Actigraphy, Ambulatory/Home, EEG Topography, Multiple Sleep Latency Test (MSLT), Nocturnal Pulse Oximetry, Polysomnography (PDF) Policy 2.01.28 (posted 8/19/14)
  • Oral Appliances for the Treatment of Sleep Related Breathing Disorders: Mandibular Repositioning Device, Nocturnal Airway Patency Appliance (NAPA), Tongue Retaining Device (PDF) Policy 1.01.07 (posted 3/17/14)
  • Measurement of Exhaled Markers of Airway Inflammation in Patients with Asthma: Exhaled Breath Condensate, Exhaled Nitric Oxide, Nioxx (PDF) Policy 2.01.41 (posted 1/23/14)
  • Lung Volume Reduction Surgery (LVRS) (PDF) Policy 7.01.14 (posted 12/9/13)
  • Electromagnetic Navigation Bronchoscopy (ENB) (PDF) Policy 6.01.40 (posted 3/26/14)
  • Bronchial Thermoplasty (e.g., Alair® System) (PDF) Policy 7.01.88 (posted 3/4/14)
  • Airway Clearance Devices: Oscillatory Devices - ABI Vest, Acapella, Flutter Valve, Lung Flute®, ThAIRapy Vest; Mechanical Percussors and Assisted Cough Devices - Cofflator, Cough-Alator, In-Exsufflator (PDF) Policy 1.01.15 (posted 1/14/14)
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