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BCBSMS Medical Policy Guidelines and Policy Development

Medical Policy consists of medical guidelines and a code reference.

Medical guidelines are developed by the Medical Policy Advisory Committee (MPAC) of Blue Cross & Blue Shield of Mississippi (BCBSMS). MPAC is comprised of physicians who are both licensed and actively practice in the state of Mississippi. Use of the Medical Policy guidelines is not intended to replace independent medical judgement for treatment of individuals. BCBSMS guidelines are written to cover a given condition for the majority of people. Each individual's unique, clinical circumstances may be considered in light of current scientific literature. Medical guidelines are based on constantly changing medical science, and BCBSMS reserves the right to review and update our policies periodically.

Code reference section of the policy provides a list of primary CPT, HCPCS and ICD-9-CM codes applicable to the policy. This section of the policy is not intended to be a comprehensive list of all codes associated with the policy. The Code Reference is updated periodically to include current codes and coding conventions. The Code Reference was developed by the BCBSMS coding staff.

Benefits and eligibility are determined before medical guidelines are applied. Therefore, medical policy is not an authorization, certification, explanation of benefits, or a contract. Benefits are determined by the group contract and the subscriber certificate that is in effect at the time services are rendered.

   

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