Medical Policy

Your benefit plan allows coverage for services that are determined to be "medically necessary." To assist in evaluating whether a service or treatment is medically necessary under the terms of your Plan, Blue Cross and Blue Shield of Texas (BCBSTX) has developed and applies medical policies.

Medical policies are based on information from:

• Scientific literature
• Criteria developed by specialty societies and
• Guidelines adopted by other health care organizations

Note that Blue Cross and Blue Shield of Texas medical policies do not represent that coverage is available or constitute plan authorization, nor should they be considered an explanation of benefits. Whether coverage is available depends upon the terms of your Plan. Check your Summary Plan Description to find out what is covered under your specific plan.

As you review medical policies, please consider the following:

• Medical policies are written for physicians and may be highly technical and complex.
• They are provided here for informational purposes only.
• Medical policies do not constitute medical advice or medical care.
• They do not guarantee any results or outcomes.
• You should discuss the information in the medical policies with your doctor, who is solely responsible for your diagnosis, treatment and medical advice.
• Medical policies serve as one of the sets of guidelines for coverage decisions. Benefits vary, and some plans may not provide coverage for certain services discussed in the medical policies.

All BCBSTX medical policies are publicly available on the BCBSTX website. View the Medical Policies