Medical Policy

The online Medical Policy Reference Manual contains approved medical policies and operating procedures for all products offered by CareFirst.

Medical policies, which are based on the most current research available at the time of policy development, state whether a medical technology, procedure, drug or device is:

  • experimental/investigational
  • cosmetic
  • medically necessary

Operating procedures provide specific benefit information and/or instructions.

Medicare Medical Policy Guidelines

For Medicare Advantage plans, the guidelines describe when certain medical services are considered medically necessary and are based on Original Medicare National Coverage Determinations (NCD's) and Local Coverage Determinations (LCD's) when available. Where no NCDs or LCDs exist, CareFirst BlueCross BlueShield Medicare Advantage will apply industry standard and CareFirst medical policies.
For further information regarding Medicare NCDs and LCDs, refer to the CMS Medicare Coverage database (MCD).

 

Medical Policies