Blue Cross and Blue Shield of Louisiana Medical Policy Coverage Guidelines
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Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc. (collectively referred to as "BCBSLA") have developed these medical policies to serve as general coverage guidelines for determining if a particular treatment, procedure or other service may be considered as a covered benefit. These medical policies are provided on this website for informational purposes only. These highly technical and highly complex policies do not constitute plan authorization or approval and do not indicate whether a particular treatment, procedure, or other service is covered for a particular individual or plan. These medical policies do not constitute medical advice or medical care. The treating health care provider is solely responsible for diagnosis, treatment and medical advice and you should discuss all information with your treating provider.
Coverage for a particular treatment, procedure, or other service depends on the particular plan and may be unavailable under certain plans, regardless of the medical policy provisions. Coverage decisions are subject to all of the terms, conditions, exclusions, and limitations of the applicable benefit plan as well as applicable state and federal laws and regulations. You should also be aware that medical technology is constantly evolving. Based on such changes and other factors, these medical policies may be changed without notice. Over time, additional medical policies may be developed and others may be removed.
The five character codes included in the BCBSLA Medical Policy Coverage Guidelines are obtained from Current Procedural Terminology (CPT®), copyright 2005 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
The responsibility for the content of BCBSLA Medical Policy Coverage Guidelines is with BCBSLA and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in BCBSLA Medical Policy Coverage Guidelines. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of BCBSLA Medical Policy Coverage Guidelines should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")
CPT only copyright 2005 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in and BCBSLA Medical Policy Coverage Guidelines solely for your own personal use in directly participating in healthcare programs administered by Blue Cross and Blue Shield of Louisiana. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.
U.S. Government Rights
This product includes CPT which is commercial technical data and/or computer databases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer databases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Disclaimer of Warranties and Liabilities.
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with BCBSLA and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
This Agreement will terminate if you violate its terms or if terminated by BCBSLA. The AMA is a third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept."
