Blue Cross Blue Shield - South Dakota Coverage Criteria
- Blue Cross Blue Shield - South Dakota prior authorization
- All Blue Cross Blue Shield - South Dakota policy updates
Latest Blue Cross Blue Shield - South Dakota coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2025-10-03Zevaksyn (prademagene zamikeracel) — Coverage CriteriaThis policy governs coverage and medical necessity determination for Zevaksyn (prademagene zamikeracel) for treatment of wounds in patients with dystrophic epidermolysis bullosa (DEB)/recessive dystrophic epidermolysis bullosa (RDEB) for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2023-03-01Pluvicto (Lutetium Lu 177 vipivotide tetraxetan) for PSMA-positive mCRPC - Coverage CriteriaPolicy governs medical necessity and coverage for therapeutic radiopharmaceutical Lu-177-PSMA-617 (Pluvicto) in adults with PSMA-positive metastatic castration-resistant prostate cancer, specifying clinical eligibility, dosing, monitoring, and discontinuation criteria for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2022-08-01Orthognathic (Jaw) Surgery Coverage CriteriaThis policy governs coverage and medical necessity criteria for orthognathic (jaw) surgery for members of Blue Cross Blue Shield - South Dakota, including preoperative planning, orthodontic phases, surgery, and postoperative care.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-12-01Laser Interstitial Thermal Therapy (LITT)This policy governs coverage and medical necessity criteria for MR-guided laser interstitial thermal therapy (LITT) for neurologic indications (brain tumors, radiation necrosis, and drug‑resistant epilepsy) for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-12-01Tumor Markers in the Management of Malignancies — Coverage CriteriaThis policy governs coverage and medical necessity criteria for laboratory tumor marker tests used in evaluation, monitoring, and management of various malignancies for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2020-01-30Vyondys 53 (golodirsen) — Coverage CriteriaThis policy governs coverage determinations for Vyondys 53 (golodirsen) for members of Wellmark Blue Cross and Blue Shield plans in South Dakota, addressing its use for Duchenne muscular dystrophy (DMD) with mutations amenable to exon 53 skipping.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-04-01Hematopoietic Stem Cell Transplantation (HSCT) — Autologous and AllogeneicCoverage criteria for autologous and allogeneic hematopoietic stem cell transplantation across multiple non-malignant and malignant indications, including specified immunodeficiencies, inherited metabolic disorders, CNS and other solid tumors, and blood cancers. Applies to Blue Cross Blue Shield - South Dakota members and providers submitting transplant requests.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2018-03-01Amniotic Membrane and Amniotic Fluid GraftsMedical policy governing clinical use and coverage decisions for human amniotic membrane (HAM) and amniotic fluid products across wound care and select ophthalmic and orthopedic indications for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-09-01Radium Ra 223 Dichloride (Xofigo)Defines medical necessity, investigational uses, and clinical requirements for coverage of radium Ra 223 dichloride (Xofigo) for adults with castration-resistant prostate cancer (CRPC) who have symptomatic bone metastases and no known visceral metastatic disease; affects providers submitting claims to Blue Cross Blue Shield - South Dakota/Wellmark.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2017-04-01Balloon Dilation of the Eustachian TubePolicy governing coverage and medical necessity criteria for balloon dilation of the eustachian tube for treatment of chronic obstructive eustachian tube dysfunction; applies to Blue Cross Blue Shield - South Dakota members and their treating providers.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2015-07-01Prostatic Urethral Lift (UroLift) Coverage CriteriaThis policy governs medical necessity and coverage criteria for prostatic urethral lift (PUL/UroLift) to treat urinary outlet obstruction due to benign prostatic hyperplasia (BPH) for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2015-04-01Bone Conduction Hearing DevicesThis policy governs medical necessity and coverage criteria for implantable and non-implantable bone-conduction and bone-anchored hearing devices for Wellmark/Blue Cross Blue Shield - South Dakota members, including prior approval requirements and replacement device criteria.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2014-11-01Tumor Treatment Fields TherapyThis policy governs coverage and medical necessity criteria for tumor treating fields (TTF) therapy (e.g., Optune®) for glioblastoma, malignant pleural mesothelioma, and non-small cell lung cancer for Wellmark Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2014-05-01Autologous Chondrocyte Implant for Focal Articular Cartilage LesionsThis policy governs coverage and medical necessity criteria for autologous chondrocyte implantation (including MACI) for symptomatic full-thickness cartilage defects of the knee and addresses investigational status for other indications and combined ACI/OATS procedures; it affects providers and members of Blue Cross Blue Shield - South Dakota.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2014-05-01Osteochondral Allografts and Autografts in the Treatment of Focal Articular Cartilage LesionsClinical coverage policy governing use of osteochondral autograft (OATS/mosaicplasty) and fresh osteochondral allograft procedures to treat focal full-thickness articular cartilage lesions of the knee, ankle (talus), elbow, and shoulder for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2013-09-01Body Composition (DXA and BIA) Coverage CriteriaThis policy governs the use and coverage stance for whole-body dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) body composition studies for clinical indications among Wellmark members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2012-04-01Air AmbulanceDefines coverage criteria, prior approval requirements, and coding for emergency and non-emergency air ambulance transport for Wellmark members; applies to providers requesting reimbursement for air medical transport services.All blue cross blue shield - south dakota updates
- Coverage CriteriaEff. 2012-04-01Manipulation under AnesthesiaDefines medical necessity, investigational uses, and clinical criteria for manipulation under anesthesia across multiple joints (shoulder, knee, spine, and other joints), summarizes evidence, and references coding. Applies to Wellmark (Blue Cross Blue Shield - South Dakota) members per plan benefits.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2011-04-01Fecal Calprotectin and Lactoferrin Testing for Inflammatory Bowel DiseaseDefines medical necessity and investigational uses for fecal calprotectin and fecal lactoferrin testing to diagnose, monitor activity, or predict relapse of inflammatory bowel disease (Crohn's disease and ulcerative colitis) for Wellmark/Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2010-01-01Surgical Treatment of Sacroiliac Joint PainDefines medical necessity and investigational indications for minimally invasive and open sacroiliac joint fusion/fixation, and lists recognized SIJ fusion devices; applies to Wellmark/Blue Cross Blue Shield - South Dakota determinations.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2009-12-01Homocysteine Testing Coverage CriteriaThis policy governs coverage and medical necessity criteria for measurement of plasma homocysteine levels, affecting clinicians ordering homocysteine testing and Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaEff. 2009-07-01Anesthesia Services for Gastrointestinal Endoscopic ProceduresDefines medical necessity criteria for monitored anesthesia care (MAC) or general anesthesia during outpatient gastrointestinal endoscopic procedures, lists not medically necessary scenarios, provides policy guidelines, clinical background, evidence summary, and related definitions. Addresses anesthesia personnel, sedation depth, and risk factors but does not include the codes table in this part.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2008-03-01Circulating Tumor Cells (CTCs) for Cancer Management — Coverage CriteriaThis policy governs use of circulating tumor cell assays (e.g., CellSearch) for screening, prognosis, prediction of therapy response, and monitoring in individuals with cancer for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2005-02-01Artificial Intervertebral Disc (Cervical and Lumbar) Coverage CriteriaPolicy governing medical necessity, investigational indications, documentation, and device-level approvals for cervical and lumbar artificial intervertebral disc implantation for Blue Cross Blue Shield - South Dakota members.All blue cross blue shield - south dakota updates
- Coverage CriteriaClinical/Medical PolicyEff. 2004-09-01Esophageal pH MonitoringThis policy governs the medical necessity and coverage of catheter-based, wireless, and impedance esophageal pH monitoring for evaluation of gastroesophageal reflux disease (GERD) in adults, children, and adolescents, including indications for surgical candidacy and specific pediatric indications.All blue cross blue shield - south dakota updates
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Tool Description
Search Blue Cross Blue Shield - South Dakota 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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