Blue Cross Blue Shield - Maine Coverage Criteria
- Blue Cross Blue Shield - Maine prior authorization
- Blue Cross Blue Shield - Maine timely filing
- All Blue Cross Blue Shield - Maine policy updates
Latest Blue Cross Blue Shield - Maine coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-28Abraxane (paclitaxel, protein bound) — Clinical Coverage CriteriaClinical coverage criteria for use of Abraxane (protein/albumin-bound paclitaxel) across oncology indications; governs prior authorization and medical necessity determinations for members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Clinical Crown LengtheningDefines clinical criteria and coding guidance for when clinical crown lengthening (hard tissue) is considered appropriate for restorative dental treatment; applies to providers and claims reviewers under the payer's dental benefit policies.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Clinical Crown Lengthening (2026 Policy) PDF. Opens in a new windowDefines clinical indications, documentation and procedural criteria for coverage of clinical crown lengthening (hard tissue) for natural teeth, including exclusions, required radiographic documentation, healing interval, and concurrent procedure rules. Coding list is informational (CDT D4249).All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Core Buildup - includes post and core proceduresPolicy governing clinical coverage and documentation requirements for core buildup and post-and-core dental procedures used to restore teeth to support crowns; applies to providers treating Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Dental Anesthesia and Sedation ServicesDefines clinical indications, monitoring, documentation, and coding guidance for local anesthesia, regional/trigeminal block, nitrous oxide, moderate sedation (intravenous and non-intravenous), deep sedation/general anesthesia for dental procedures; explains medical necessity criteria and required supporting documentation and monitoring standards.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Gingival Flap Procedure and Apically Positioned FlapClinical guidance for when gingival flap procedures and apically positioned flaps are appropriate for treatment of periodontal disease; applies to providers submitting claims to Blue Cross Blue Shield - Maine.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Gingivectomy or Gingivoplasty Coverage CriteriaClinical policy governing indications, contraindications, documentation, and coding for gingivectomy and gingivoplasty procedures for members covered by Blue Cross Blue Shield - Maine.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Guided Tissue Regeneration (2026 Policy) PDF. Opens in a new windowDefines clinical indications, documentation requirements, limitations, and coding guidance for guided tissue regeneration procedures in dental care for Blue Cross Blue Shield - Maine. Applies to periodontal and peri-implant defects, with contract-dependent exceptions.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Mucogingival Surgery and Soft Tissue GraftingClinical policy governing medical necessity, documentation, and coverage criteria for mucogingival surgery and soft tissue grafting for Blue Cross Blue Shield - Maine members; applies to dental/perio procedures and providers submitting claims.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Periodontal Bone Grafting — Coverage CriteriaCovers clinical indications, documentation requirements, coding, and coverage criteria for periodontal bone grafting procedures for retained natural teeth and peri-implant defects under the payer's dental policy.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Periodontal MaintenanceDefines periodontal maintenance as the nonsurgical, ongoing therapeutic care following definitive periodontal treatment for patients with a history of periodontal disease; governs dental providers delivering maintenance and billing guidance for members of Blue Cross Blue Shield - Maine.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-01-01Periodontal Surgical Procedures, miscellaneousDefines medical necessity criteria, documentation requirements, and benefit determinations for miscellaneous periodontal surgical procedures (e.g., anatomical crown exposure, surgical revision, mesial/distal wedge) for Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Biological Materials to Aid in Soft Tissue and Osseous Tissue Regeneration (Endodontic)Policy governing use and coverage criteria for biological materials used to promote soft tissue and bone regeneration in dental/endodontic procedures for Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Clinical Crown LengtheningThis policy defines clinical indications, criteria, and coding guidance for clinical crown lengthening procedures for dental providers and claims reviewers under Blue Cross Blue Shield - Maine.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Core Buildup - includes post and core proceduresDefines clinical criteria, documentation, and coding guidance for coverage of core buildups and prefabricated or indirect post-and-core procedures for dental members under the payer's dental policies.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Crowns, Inlays, and Onlays Coverage CriteriaThis policy governs benefit determination and documentation requirements for dental indirect restorations (crowns, inlays, onlays) for Blue Cross Blue Shield - Maine members; it applies to providers submitting claims for these services and depends on member contract terms.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Endodontic Therapy (Dental Clinical Policy)Clinical policy governing coverage and medical necessity criteria for endodontic (root canal and related) procedures for Blue Cross Blue Shield - Maine members; applies to providers submitting claims and utilization reviews.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Gingivectomy or Gingivoplasty Coverage CriteriaClinical coverage guidelines for gingivectomy and gingivoplasty procedures for Blue Cross Blue Shield - Maine members, describing indications, contraindications, documentation and coding expectations for dental providers.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Guided tissue regeneration (dental) coverage criteriaPolicy governing coverage and clinical criteria for guided tissue regeneration procedures for periodontal and peri-implant defects for Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Implant/Abutment Supported Fixed Prosthetics - Crowns and Fixed Partial DenturesDefines clinical indications, documentation and coverage constraints for implant/abutment supported crowns and fixed partial dentures under Blue Cross Blue Shield - Maine dental clinical policy; includes procedural coding lists for informational purposes and references contract-dependent exclusions and alternate benefit provisions.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Implant/Abutment Supported Fixed Prosthetics - Crowns and Fixed Partial DenturesDefines clinical indications, documentation and coverage criteria for dental implant- and abutment-supported crowns and fixed partial dentures for Blue Cross Blue Shield - Maine members; applies to dental providers submitting claims for implant prosthetics.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Local Delivery of Chemotherapeutic Agents/Antimicrobial AgentsGuidance on when local delivery of chemotherapeutic or antimicrobial agents (LDCA/LDAA) is appropriate as adjunctive therapy for periodontal disease management, affecting dental providers treating periodontitis for Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Orthodontia - Medically Necessary Orthodontia CareDefines clinical criteria, documentation, coding guidance, and review requirements for determination of medically necessary orthodontic treatment under the dental plan; applies to providers and members whose contracts allow medical/dental necessity review.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Periodontal Surgical Procedures, miscellaneousPolicy governing coverage and documentation requirements for miscellaneous periodontal surgical procedures (including anatomical crown exposure, surgical revision, and mesial/distal wedge) for Blue Cross Blue Shield - Maine members.All Blue Cross Blue Shield - Maine updates
- Coverage CriteriaClinical/Medical PolicyEff. 2025-01-01Scaling and Root PlaningDefines clinical indications, documentation, and coding guidance for periodontal scaling and root planing and related procedures for Blue Cross Blue Shield - Maine members; applies to providers performing nonsurgical periodontal therapy.All Blue Cross Blue Shield - Maine updates
1–25 of 75
1 / 3
Tool Description
Search Blue Cross Blue Shield - Maine 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.
Coverage Criteria by Payer
Go deeper
Explore OpenPayer Data
Coverage policies are updated every day. Follow payer coverage policy updates in the live policy feed, or browse all CPT, HCPCS and DRG billing codes.
Toolbox
More OpenPayer Tools
- Billing Code LookupSearch CPT, HCPCS, J-codes, DRG, and dental codes by number or procedure name.
- Billing Code Reimbursement RatesBuild a reimbursement rate report across any mix of billing codes and states, comparing commercial payers against Medicare.
- Payer Comparison DashboardPick 2-5 payers to compare market share, premium, and membership by region, all at once.
- Facility Comparison DashboardPick 2-6 hospital facility types (or add a specific hospital) to compare facility count, revenue, net income, and Medicare/Medicaid payer mix by region, all at once.
- Healthcare Provider & Facility LookupFind hospitals and healthcare facilities by name, taxonomy, facility type, ownership, or state.
- Health Insurance Payer LookupSearch national health insurance payers and health plans by name and state presence.
- Provider Taxonomy Code LookupSearch NUCC taxonomy codes by code, specialty, grouping, or classification.
- CPT Modifier LookupSearch CPT modifiers by code or name — descriptions, when to use them, and payer policy context.
- Prior Authorization LookupSearch payer prior authorization policies by drug, procedure, or policy name.
- Timely Filing LookupFind payer timely filing policies: claim deadlines, corrected claim windows, and appeal timeframes.
- Payer Contact DirectoryClaims, prior authorization, provider services, and appeals contacts for health insurance payers.
Published by
Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.