Blue Cross Blue Shield - Tennessee Coverage Criteria
- Blue Cross Blue Shield - Tennessee prior authorization
- All Blue Cross Blue Shield - Tennessee policy updates
Latest Blue Cross Blue Shield - Tennessee coverage criteria updates25
- Coverage CriteriaClinical/Medical PolicyEff. 2026-09-01Secukinumab (Cosentyx) — Coverage CriteriaMedical policy governing prior authorization, coverage criteria, and documentation requirements for secukinumab (Cosentyx) for FDA‑approved indications and compendial uses for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Carfilzomib (Kyprolis) — Coverage Criteria for Multiple Myeloma and Related Plasma Cell DisordersCovers medical necessity criteria, dosing limits, and prior authorization requirements for Kyprolis (carfilzomib) for multiple myeloma and related plasma cell disorders for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Circulating tumor DNA (liquid biopsy) companion diagnostic assaysDefines medical necessity criteria for use of circulating tumor DNA (liquid biopsy) companion diagnostic assays to guide prescribing of FDA‑approved companion diagnostic‑linked medications in advanced/metastatic solid tumors, and states that tumor‑informed ctDNA testing using Signatera™ is investigational.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Daratumumab (Darzalex) — Coverage CriteriaDefines prior authorization, coverage criteria, and authorization durations for daratumumab (Darzalex) across FDA-approved and compendial oncology indications for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Denosumab products (Prolia and listed biosimilars) for osteoporosis and cancer-related bone loss — Coverage CriteriaPolicy governs coverage criteria, authorization duration, documentation, and dosing limits for denosumab products (Prolia and listed biosimilars) for osteoporosis, glucocorticoid-induced osteoporosis, and prevention of treatment-related bone loss in prostate and breast cancer. It applies to members of the payer (Blue Cross Blue Shield - Tennessee).All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Evenity (romosozumab) — Coverage Criteria for Postmenopausal OsteoporosisCovers prior authorization, coverage criteria, and limitations for Evenity (romosozumab) for treatment of osteoporosis in postmenopausal women at high risk for fracture for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Evinacumab (Evkeeza) for Homozygous Familial Hypercholesterolemia — Coverage CriteriaCovers prior authorization, clinical criteria, and continuation requirements for evinacumab (Evkeeza) as adjunct therapy to lower LDL-C in patients with homozygous familial hypercholesterolemia (HoFH) for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Inclisiran (Leqvio) — Coverage Criteria for HypercholesterolemiaThis policy governs prior authorization, coverage criteria, and documentation requirements for inclisiran (Leqvio) to reduce LDL-C in adults with hypercholesterolemia, including heterozygous familial hypercholesterolemia, for Blue Cross Blue Shield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Lamzede (velmanase alfa) for alpha-mannosidosis — Coverage CriteriaCovers use of Lamzede for treatment of non‑central nervous system manifestations of alpha‑mannosidosis for Blue Cross Blue Shield of Tennessee members when authorization criteria are met; applies to providers seeking prior authorization and continued therapy.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Lanreotide (Somatuline® Depot) coverageDefines prior authorization, coverage criteria, and documentation requirements for lanreotide (Somatuline® Depot) for FDA‑approved and compendial indications for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Octreotide (Sandostatin LAR) injectable suspension — Coverage CriteriaDefines coverage, prior authorization requirements, and clinical indications for Sandostatin LAR (octreotide acetate for injectable suspension) for Blue Cross Blue Shield Tennessee members when approval criteria are met.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Pasireotide (Signifor LAR) — Coverage CriteriaDefines prior authorization, documentation, and coverage criteria for pasireotide (Signifor LAR) for treatment of acromegaly and Cushing's disease for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Rivfloza (for primary hyperoxaluria type 1) Coverage CriteriaPolicy governs coverage and prior authorization requirements for Rivfloza to lower urinary oxalate in patients with primary hyperoxaluria type 1 (PH1) with preserved kidney function; affects providers prescribing the drug and BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Ryplazim (plasminogen) for plasminogen deficiency type 1 — Coverage CriteriaCovers use of Ryplazim (plasma-derived human plasminogen) for treatment of members with plasminogen deficiency type 1 when approval criteria are met; applies to BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Selinexor (Sarclisa) — Coverage Criteria for Multiple Myeloma and Related Plasma Cell DisordersThis policy governs coverage and authorization criteria for selinexor (Sarclisa) for FDA-approved and compendial indications in members of BlueCross BlueShield of Tennessee, including multiple myeloma and certain plasma cell disorders.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31Skysona (gene therapy) for cerebral adrenoleukodystrophy (CALD)Covers medical necessity criteria, prior authorization, documentation, exclusions, and monitoring requirements for use of Skysona in boys with early, active cerebral adrenoleukodystrophy (CALD) for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-07-31iDose TR (travoprost intracameral implant) — Coverage Criteria and Prior AuthorizationPolicy governing prior authorization, coverage criteria, continuation, and exclusions for iDose TR for reduction of intraocular pressure in patients with open-angle glaucoma or ocular hypertension for BlueCross BlueShield of Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Aflibercept Products (intravitreal) coverage criteriaCoverage policy for Eylea and listed biosimilars/brands for ophthalmologic indications (e.g., diabetic retinopathy, DME, wet AMD, RVO macular edema, ROP) including authorization durations and dosing limits; applies to BlueCross BlueShield of Tennessee members and providers.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Corneal collagen cross-linking (CXL) — Coverage CriteriaDefines medical necessity and investigational use of corneal collagen cross-linking for progressive keratoconus and post‑refractive surgery corneal ectasia for Blue Cross Blue Shield - Tennessee members and providers.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Denosumab (Prolia and biosimilars) — Coverage CriteriaCovers medical necessity, authorization criteria, continuation rules, quantity limits, and documentation requirements for denosumab products (Prolia and biosimilars) for osteoporosis, glucocorticoid-induced bone loss, and treatment-related bone loss in prostate and breast cancer patients. Applies to members and providers under the payer's plan.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Denosumab Products (Xgeva® and biosimilars) — Coverage CriteriaGoverns medical policy coverage, authorization durations, and dosing limits for denosumab products for oncology-related indications for Blue Cross Blue Shield - Tennessee members.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Enhertu (fam-trastuzumab deruxtecan‑nxki) — Coverage CriteriaThis policy governs prior authorization, coverage criteria, and quantity limits for Enhertu (fam-trastuzumab deruxtecan-nxki) for Blue Cross Blue Shield - Tennessee members for specified HER2-related oncologic indications.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Opdivo Qvantig (nivolumab biosimilar) — Coverage CriteriaThis policy describes indications, prior authorization requirements, documentation, exclusions, and authorization durations for Opdivo Qvantig for Blue Cross Blue Shield of Tennessee members. It applies to providers requesting coverage for the listed oncology indications when approval criteria are met.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Pembrolizumab (Keytruda) — Oncology coverage criteriaDefines covered oncology indications for pembrolizumab (Keytruda) for Blue Cross Blue Shield - Tennessee members when approval criteria are met; applies to providers requesting coverage for listed cancer indications.All blue cross blue shield - tennessee updates
- Coverage CriteriaClinical/Medical PolicyEff. 2026-06-30Tecentriq (atezolizumab) — coverage criteria for oncology indicationsPolicy governs coverage and prior authorization criteria for Tecentriq (atezolizumab) for approved and compendial oncology indications for Blue Cross Blue Shield - Tennessee members.All blue cross blue shield - tennessee updates
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Tool Description
Search Blue Cross Blue Shield - Tennessee 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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