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Blue Cross and Blue Shield of Montana policies, page 8

Search Blue Cross and Blue Shield of Montana's public medical, payment and drug policies by CPT or HCPCS code, keyword or policy number, with links to the payer's own documents. Links open the payer's own document; check its current version before relying on it.

425 public policies Substrate tracks for Blue Cross and Blue Shield of Montana, by title.

Blue Cross and Blue Shield of Montana policies
PolicyDetailsCodesSource
Sensory Integration Therapy and Auditory Integration TherapyTHE803.020 · Effective Sep 15, 2026 · Commercial, Medicaid1Original policy ↗
Serum Biomarker Panel Testing for Systemic Lupus Erythematosus and Other Connective Tissue DiseasesMED207.159 · Commercial, Medicaid20Original policy ↗
Sexual Dysfunctions, Assessment and TreatmentMED201.030 · Commercial, Medicaid64Original policy ↗
Shoulder ResurfacingSUR705.032 · Commercial, Medicaid3Original policy ↗
Sleep Related Breathing Disorders: Surgical ManagementSUR706.009 · Effective Jan 1, 2026 · Commercial, Medicaid40Original policy ↗
Small Bowel/Liver and Multivisceral TransplantSUR703.009 · Commercial, Medicaid26Original policy ↗
Specialty Medication Administration Site of CareADM1001.034 · Commercial123Original policy ↗
Speech Generating Devices (SGD)DME104.009 · Commercial, Medicaid13Original policy ↗
Speech-Language Therapy (SLT)THE803.014 · Commercial, Medicaid13Original policy ↗
Spesolimab-sbzoRX501.181 · Commercial, Medicaid1Original policy ↗
Sphenopalatine Ganglion Block for HeadacheMED205.039 · Effective Aug 15, 2025 · Commercial, Medicaid7Original policy ↗
Spinal Cord Stimulation (SCS) and Dorsal Root Ganglion (DRG) StimulationSUR712.009 · Effective Aug 1, 2026 · Commercial, Medicaid30Original policy ↗
Stationary Ultrasonic Diathermy DevicesTHE801.039 · Commercial, Medicaid2Original policy ↗
Stem Cell Therapy for Peripheral Arterial DiseaseSUR703.048 · Effective Apr 15, 2026 · Commercial, Medicaid3Original policy ↗
Sublingual Immunotherapy as a Technique of Allergen-Specific TherapyMED206.006 · Commercial, Medicaid3Original policy ↗
Subtalar ArthroereisisSUR705.027 · Commercial, Medicaid5Original policy ↗
Surface Electrical StimulationMED201.026 · Commercial, Medicaid7Original policy ↗
Surface Electromyography and Paraspinal Surface Electromyography to Evaluate and Monitor Back PainMED205.006 · Effective Oct 1, 2025 · Commercial, Medicaid6Original policy ↗
Surgery for Groin Pain in AthletesSUR705.036 · Commercial, Medicaid3Original policy ↗
Surgical Deactivation of Headache Trigger SitesSUR712.031 · Commercial, Medicaid12Original policy ↗
Surgical Left Atrial Appendage Occlusion Devices for Stroke Prevention in Atrial FibrillationSUR707.033 · Effective Jan 1, 2026 · Commercial, Medicaid3Original policy ↗
Surgical Treatment of Femoroacetabular ImpingementSUR705.029 · Commercial, Medicaid7Original policy ↗
Surgical Treatment of GynecomastiaSUR716.017 · Commercial, Medicaid2Original policy ↗
Surgical Treatments for Breast Cancer-Related LymphedemaSUR701.024 · Effective Dec 15, 2025 · Commercial, Medicaid17Original policy ↗
Surgical Ventricular RestorationSUR707.026 · Commercial, Medicaid1Original policy ↗
Sutimlimab-jomeRX501.180 · Commercial, Medicaid1Original policy ↗
Temporarily Implanted Nitinol Device (iTind) for Benign Prostatic HyperplasiaMED201.025 · Effective Apr 1, 2026 · Commercial, Medicaid3Original policy ↗
Temporomandibular Joint DisordersSUR705.010 · Commercial, Medicaid96Original policy ↗
Teplizumab-mzwvRX501.150 · Effective Apr 1, 2026 · Commercial, Medicaid1Original policy ↗
Teprotumumab-trbwRX501.110 · Commercial, Medicaid1Original policy ↗
Tests for Amniotic Protein to Detect Rupture of Membranes (ROM) in PregnancyOB401.018 · Commercial, Medicaid2Original policy ↗
Tezepelumab-ekkoRX501.143 · Commercial, Medicaid1Original policy ↗
Therapeutic Embolization and Vessel Occlusion to Treat Pelvic ConditionsSUR701.015 · Effective Jan 1, 2026 · Commercial, Medicaid9Original policy ↗
ThermographyRAD601.014 · Commercial, Medicaid2Original policy ↗
Tibial Nerve StimulationMED205.035 · Effective Jan 1, 2026 · Commercial, Medicaid11Original policy ↗
Tildrakizumab-asmnRX501.123 · Commercial, Medicaid1Original policy ↗
Tocilizumab and Associated Biosimilar(s)RX501.115 · Commercial, Medicaid4Original policy ↗
Tonic Motor Activation for Restless Legs SyndromeDME101.053 · Effective Apr 15, 2026 · Commercial, Medicaid2Original policy ↗
Transanal Endoscopic MicrosurgerySUR701.040 · Effective Apr 1, 2025 · Commercial, Medicaid1Original policy ↗
Transanal Radiofrequency (RF) Treatment of Fecal IncontinenceMED201.029 · Commercial, Medicaid1Original policy ↗
Transcatheter Aortic-Valve Implantation for Aortic StenosisSUR707.028 · Commercial, Medicaid11Original policy ↗
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver MalignanciesTHE801.022 · Effective Dec 1, 2025 · Commercial, Medicaid4Original policy ↗
Transcatheter Mitral Valve Repair or ReplacementSUR707.025 · Effective Jan 1, 2026 · Commercial, Medicaid6Original policy ↗
Transcatheter Pulmonary Valve ImplantationSUR707.029 · Effective Oct 15, 2025 · Commercial, Medicaid1Original policy ↗
Transcatheter Tricuspid Valve Repair or ReplacementSUR707.032 · Effective Nov 15, 2025 · Commercial, Medicaid3Original policy ↗
Transcranial Magnetic Stimulation as a Treatment of Depression and Other Psychiatric/Neurologic DisordersPSY301.015 · Effective Jan 1, 2026 · Commercial, Medicaid8Original policy ↗
Transcutaneous Electrical Stimulation (TENS) and Transcutaneous Afferent Patterned StimulationMED201.040 · Effective Jun 15, 2026 · Commercial, Medicaid13Original policy ↗
Treatment for Duchenne Muscular DystrophyRX501.084 · Effective Aug 15, 2025 · Commercial, Medicaid5Original policy ↗
Treatment of Congenital AthymiaRX501.139 · Effective Dec 15, 2025 · Commercial, Medicaid3Original policy ↗
Treatment of HyperhidrosisMED201.014 · Commercial, Medicaid20Original policy ↗

Back to Blue Cross and Blue Shield of Montana · Blue Cross and Blue Shield of Montana prior authorization CPT list

Disclaimer

The information provided on this page is for general informational purposes only and does not constitute billing, coding, or reimbursement advice. Nothing on this page should be relied upon as a substitute for clinician assessment, professional billing guidance, or as a definitive statement of any payor's billing requirements or policies.

Payor agreements, fee schedules, and billing policies vary and are subject to change. Before submitting any claims related to maternity care services, including claims affected by the 2027 CPT code revisions, please consult the applicable payor agreements, coverage policies, and billing guidelines to confirm current requirements for their specific payor contracts.

Substrate makes no representation or warranty regarding the accuracy, completeness, or timeliness of the payor-specific information presented here. Providers are solely responsible for ensuring that all claims are submitted in accordance with applicable payor requirements, and Substrate assumes no liability for claim denials, underpayments, or other adverse outcomes arising from reliance on this information.

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