Blue Cross Blue Shield - Kansas Coverage Criteria
- Blue Cross Blue Shield - Kansas prior authorization
- All Blue Cross Blue Shield - Kansas policy updates
Latest Blue Cross Blue Shield - Kansas coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-08Beqvez (fidanacogene elaparvovec) — Coverage CriteriaCoverage policy for a single-dose AAV-based gene therapy (Beqvez / fidanacogene elaparvovec) for adults with moderate-to-severe congenital Factor IX deficiency, including authorization, dosing, monitoring, and coding guidance for BCBSKS members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-06-10Automated Insulin Delivery SystemsDefines medical necessity, FDA-status considerations, and coverage criteria for automated insulin delivery (AID) systems for members of Blue Cross and Blue Shield of Kansas, including indications for type 1 and type 2 diabetes and exclusions for non-FDA–cleared devices.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-04-23Catheter Ablation as Treatment for Atrial FibrillationDefines medical necessity criteria, indications, repeat procedure policy, investigational exclusions, and procedural context for transcatheter radiofrequency, cryoablation, and pulsed field ablation to treat atrial fibrillation for BCBSKS members. Applies to symptomatic paroxysmal or persistent AF, AF with heart failure as an alternative to AV nodal ablation/pacing, initial therapy in recurrent symptomatic paroxysmal AF, and repeat procedures.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-03-13Analysis of Human DNA or RNA in Stool Samples as a Technique for Colorectal Cancer ScreeningThis policy addresses use of stool-based testing that analyzes human DNA or RNA (FIT-DNA / FIT-RNA) as a screening technique for colorectal cancer in asymptomatic, average-risk adults and governs coverage determinations for Blue Cross Blue Shield of Kansas members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-11-20Virtual Colonoscopy / CT ColonographyDefines coverage and clinical criteria for CT colonography (virtual colonoscopy) as a colorectal cancer screening alternative for Blue Cross and Blue Shield of Kansas members, and summarizes evidence and intended use.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-08-01ACA Prevention Copay Waiver Criteria - Marketplace, CommercialDefines clinical criteria for approving a copay waiver for ACA-preventive pharmaceutical agents (breast cancer primary prevention agents, contraceptives, HIV PrEP, and statins) for BCBSKS marketplace and commercial members; applies to pharmacy benefit or coverage-exception approvals.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-05-23Cardiac Rehabilitation in the Outpatient SettingThis policy governs coverage and medical necessity criteria for outpatient cardiac rehabilitation programs for Blue Cross Blue Shield of Kansas members, specifying eligible conditions, program requirements, and interventions considered experimental/investigational.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2024-01-01Carrier Screening for Genetic DiseasesThis policy governs medical necessity and coverage criteria for targeted risk-based and non-targeted carrier screening for autosomal recessive and X-linked single-gene disorders in individuals who are pregnant or considering pregnancy. It applies to providers and members covered by Blue Cross and Blue Shield of Kansas.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-11-17Botulinum Toxin (BT)This policy governs medical necessity and coverage criteria for use of botulinum toxin products (various FDA-approved formulations) for neurologic, urologic, gastroenterologic, and other indications, and identifies indications considered experimental/investigational or noncovered. It applies to Blue Cross and Blue Shield of Kansas members and providers billing BCBSKS.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-10-02Total Artificial Hearts and Ventricular Assist DevicesMedical policy governing the use, indications, and coverage stance for ventricular assist devices (implantable and percutaneous) and total artificial hearts for members of Blue Cross and Blue Shield of Kansas.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-07-13Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic ConditionsDefines medical necessity criteria, policy guidelines, and investigational exclusions for charged-particle (proton or helium ion) radiotherapy across multiple neoplastic conditions (uveal melanoma, skull-based tumors including chordoma/chondrosarcoma, pediatric CNS and non-CNS tumors, NSCLC, head and neck cancers, localized prostate cancer). Includes background, rationale, dosimetry tolerance tables, and evidence summaries.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-04-27Temporomandibular Joint (TMJ) DisorderThis policy governs diagnostic testing and therapeutic interventions for suspected or confirmed temporomandibular joint disorder (TMJD) for Blue Cross Blue Shield of Kansas members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-11-09Contrast-Enhanced Coronary Computed Tomography Angiography (CCTA) for Coronary Artery EvaluationThis policy governs the medical necessity and coverage criteria for contrast-enhanced coronary CT angiography (CCTA) to evaluate coronary arteries for Blue Cross Blue Shield of Kansas members, including use in acute chest pain, stable chest pain, and suspected anomalous coronary arteries.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-10-28Positron Emission Tomography (PET) Scanning: Cardiac ApplicationsCoverage policy for PET cardiac applications (myocardial perfusion, viability, cardiac sarcoidosis, and myocardial blood flow quantification) for Blue Cross and Blue Shield of Kansas members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2021-06-03Balloon Dilation of the Eustachian TubeThis policy governs coverage criteria for balloon dilation of the eustachian tube for members of Blue Cross and Blue Shield of Kansas, specifying clinical eligibility, diagnostic requirements, contraindications, and when the procedure is considered investigational.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-04-08Autologous Chondrocyte Implantation for Focal Articular Cartilage LesionsDefines medical necessity criteria, guidelines, and regulatory context for autologous chondrocyte implantation in focal full‑thickness articular cartilage defects of the knee and states ACI for other joints is investigational. Applies to BCBS Kansas members and providers.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2019-09-11Adjustable Cranial Orthosis (Helmets) for Infants — Coverage CriteriaPolicy governing medical necessity and coverage criteria for adjustable cranial orthoses used after craniosynostosis surgery and for positional plagiocephaly/brachycephaly in pediatric members of Blue Cross Blue Shield of Kansas.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2019-04-26Hyperbaric Oxygen Therapy (HBOT)This medical policy governs coverage and medical necessity criteria for systemic and topical hyperbaric oxygen therapy for Blue Cross and Blue Shield of Kansas members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2019-02-01Interspinous and Interlaminar Stabilization / Distraction Devices (Spacers)This policy governs coverage determinations for interspinous and interlaminar spacer devices used to treat lumbar spinal stenosis, including as stand-alone implants or when used following decompression surgery, for Blue Cross and Blue Shield of Kansas members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2016-03-31Insulin PumpDefines Blue Cross and Blue Shield of Kansas coverage criteria and coding guidance for external insulin infusion pumps for members, including prerequisites, clinical considerations, and coding lists. Applies to BCBSKS members and providers managing insulin pump therapy.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2015-12-07Off-Label, Orphan, and Expanded Access Drug Use — Coverage CriteriaPolicy governing coverage criteria for off-label use of FDA-approved drugs, orphan drugs, and expanded access (compassionate use) investigational drugs for BCBS Kansas members and administered providers.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2011-06-27Periodontal Soft Tissue GraftingClinical coverage criteria and guidelines for periodontal soft tissue graft procedures (autografts and allografts) for Blue Cross and Blue Shield of Kansas members. Applies to providers submitting claims for soft tissue grafting services for eligible members.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2010-06-29Total Ankle Replacement (TAR) Coverage PolicyThis medical policy governs coverage and medical necessity criteria for total ankle replacement (arthroplasty) using FDA‑approved devices for BCBS Kansas members; it outlines indications, contraindications, and the insurer's coverage stance. It applies to providers performing TAR and to members whose benefits are administered by BCBSKS.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2006-12-12Catheter Ablation as Treatment for Atrial FibrillationThis policy governs coverage for transcatheter catheter ablation (radiofrequency, cryoablation, and pulsed field ablation) as treatment for symptomatic atrial fibrillation for Blue Cross Blue Shield of Kansas members, including indications, repeat procedures, and investigational uses.All blue cross blue shield - kansas updates
- Coverage CriteriaClinical/Medical PolicyEff. 2004-07-13Adjustable Cranial Orthoses for Positional Plagiocephaly and CraniosynostosesThis policy governs coverage criteria for the use of adjustable cranial orthoses (helmets/bands) in infants with positional plagiocephaly (nonsynostotic) and as postoperative therapy following cranial vault remodeling for craniosynostosis, affecting BCBSKS members and their providers.All blue cross blue shield - kansas updates
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Tool Description
Search Blue Cross Blue Shield - Kansas coverage criteria and medical necessity requirements across 21,000+ policies from 170+ payers.
Search a drug (“Wegovy”), a procedure (“knee replacement”), or a policy name, then filter by payer, specialty, policy type, or effective year. Or start from the largest publishers: UnitedHealthcare coverage criteria and Cigna coverage criteria.
Each result links the full policy page, which lists the clinical requirements, covered codes, and effective dates from the source document.
Pair a criteria search with the prior authorization lookup for approval requirements, the timely filing lookup for claim deadlines, the live policy updates feed for the newest payer publications, and payer profiles for contacts and coverage context.
FAQ
Coverage criteria are the specific clinical requirements a payer sets for covering a drug, procedure, or service: diagnoses, symptom duration, prior treatments tried, age limits, and documentation. They are published inside medical policies and clinical criteria documents, and a claim or authorization that does not meet them is denied as not medically necessary.
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