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Medical Policies

We strive to offer our members the latest in proven medical technologies by reviewing current scientific evidence and considering expert physician opinion when we develop our medical policies. Each month, our Medical Policy Group meets to review the policies for a specific specialty. We incorporate input from the Massachusetts Medical Society, specialty societies, national technology review organizations and community physicians in the development and review of all policies.

Additional information about our medical policies

  • Searching for a medical policy? For the best results, search on the medical policy site by category, policy number, procedure code, or alphabetically.
  • Medical policies for Federal Employee Program members: Find them on fepblue.org
  • Medical policies for Medicare Advantage members: We are required to make coverage determinations for services through the CMS National Coverage Determination (NCD) policies and benefit manuals. In addition, we follow Local Coverage Determination (LCD) policies established by the Massachusetts Medicare Administrative Contractors. When there is no NCD or LCD, we follow our commercial medical policies for Medicare Advantage members. Refer to medical policy 132, Medicare Advantage Management, for a directory of commercial and Medicare policies.