Blue Cross of Northeastern Pennsylvania ("BCNEPA") Medical Policy


Medical policies are provided for informational purposes only. They are developed to assist in administering plan benefits and do not constitute medical advice.

Because they are intended for medical professionals, medical policies are written using medical language and terminology. We encourage members to share BCNEPA's medical policies with their doctor and/or medical professional who may help them more fully understand how they relate to their specific health care needs.

Note regarding experimental/investigative services policies: BlueCare HMO does not cover experimental and investigative services. However, if a doctor feels this type of service would be most appropriate for their patient's care, requests for experimental and investigational treatment are reviewed on a case by case basis.

Number Topic Section
MPO-490-0122
AbortionsSurgery
MPO-490-0012
Allergy TestingMedical
MPO-490-0034
Ambulance TransportationMedical
MPO-490-0099
Blood Medical
MPO-490-0070
BrachytherapyRadiology
MPO-490-0118
Cardiac Event MonitorsMedicine
MPO-490-0007
Cardiac Rehabilitation ProgramsCardiology
MPO-490-0016
Chiropractic CareMiscellaneous
MPO-490-0031
Cochlear ImplantationSurgery
MPO-490-0150
Contrast Enhanced Cardiac Computed Tomography A...Radiology
MPO-490-0027
Cosmetic Procedures vs. Reconstructive ProceduresSurgery
MPO-490-0115
Diabetic Services and SuppliesMedical
MPO-490-0006
Durable Medical Equipment (DME)Medical
MPO-490-0025
Electrical Bone Growth StimulationMedical
MPO-490-0018
Electrical/Neuromuscular StimulatorMedical
MPO-490-0077
Endometrial AblationOB/GYN
MPO-490-0147
Enhanced External Counterpulsation (EECP)Surgery
MPO-490-0133
Experimental/Investigative Services AnesthesiaMedical
MPO-490-0135
Experimental/Investigative Services Durable Med...Medical
MPO-490-0138
Experimental/Investigative Services MedicineMedical
MPO-490-0136
Experimental/Investigative Services Miscellaneo...Medical
MPO-490-0132
Experimental/Investigative Services Obstetrical...Medical
MPO-490-0134
Experimental/Investigative Services Pathology/L...Medical
MPO-490-0137
Experimental/Investigative Services RadiologyMedical
MPO-490-0139
Experimental/Investigative Services SurgeryMedical
MPO-490-0140
Experimental/Investigative Services TherapyMedical
MPO-490-0108
Foot Care ServicesMedical
MPO-490-0155
Gene Expression Markers (Oncotype DX™ Testing)Medicine
MPO-490-0083
Genetic TestingPathology
MPO-490-0045
Home Neonatal PhototherapyHome Care
MPO-490-0125
Hyperbaric Oxygen (HBO) TherapyMedical
MPO-490-0154
Implantable Bone-Conduction and Bone-Anchored H...Surgery
MPO-490-0072
Impotence/Erectile Dysfunction - MaleMedical
MPO-490-0050
InfertilityMedical
MPO-490-0145
KyphoplastySurgery
MPO-490-0088
Laparoscopic SurgerySurgery
MPO-490-0023
LithotripsySurgery
MPO-490-0021
Lung Volume Reduction Surgery (LVRS)Surgery
MPO-490-0117
Mental HealthMental Health
MPO-490-0015
Metabolic FormulasMiscellaneous
MPO-490-0153
Microprocessor-Controlled Prosthetic KneesDME
MPO-490-0146
Morbid ObesitySurgery
MPO-490-0141
MRI of the BreastRadiology
MPO-490-0010
Oral SurgeryOral Surgery
MPO-490-0148
Osteoarticular Transfer System (OATS)/Autologou...Surgery
MPO-490-0039
Outpatient TherapiesTherapy
MPO-490-0151
Panniculectomy and AbdominoplastySurgery
MPO-490-0003
PhotochemotherapyInternal Medicine
MPO-490-0131
Photodynamic TherapyVision
MPO-490-0127
Plasmapheresis (Plasma Exchange)Therapy
MPO-490-0002
Positron Emission Tomography (PET)Radiology
MPO-490-0149
Power Operated Vehicles (POV)Miscellaneous
MPO-490-0075
Preventive ServicesMedical
MPO-490-0092
Prophylactic SurgeriesSurgery
MPO-490-0009
Prosthetics and OrthoticsMedical
MPO-490-0091
Psychological TestingMental Health
MPO-490-0144
Serum Tumor MarkersMedical
MPO-490-0035
Sleep Disorder ServicesMedical
MPO-490-0069
Stereotactic RadiosurgeryRadiology
MPO-490-0152
Transcranial Doppler (TCD) Ultrasounds Radiology
MPO-490-0120
Transmyocardial RevascularizationSurgery
MPO-490-0001
TransplantSurgery-Transplant
MPO-490-0089
Transurethral Microwave ThermotherapySurgery
MPO-490-0126
Uterine Artery Embolization (UAE)OB/GYN
MPO-490-0123
Wound CareMedicine

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Serving Bradford, Carbon, Clinton, Lackawanna, Luzerne, Lycoming, Monroe, Pike, Sullivan, Susquehanna, Tioga, Wayne and Wyoming Counties.
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Licensee of the BlueCross BlueShield Association. All rights reserved.