Fitness Reimbursement Request
To verify this reimbursement is offered within your plan, please log on to MyBlue® at bluecrossma.com/myblue or call the Member Service number on your ID card. You have until March 31 of the following year to submit this form.
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2 For medical necessity criteria and coding guidance for Medicare Advantage members living outside of Massachusetts, please see the Centers for Medicare and Medicaid Services website for information
2 The patency capsule is considered INVESTIGATIONAL, including the use to evaluate patency of the GI tract before wireless capsule endoscopy…
5 New investigational indications described. Coding information clarified. Effective 10/1/2014. 7/2014 Updated Coding section with ICD10 procedure and diagnosis codes, effective 10/2015.
1 Medical Policy Gene Therapy for Inherited Retinal Dystrophy Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies
3 The above medical necessity criteria MUST be met for the following codes to be covered for Commercial Members: Managed Care (HMO and POS), PPO, and Indemnity:
1 Medical Policy Thermal Capsulorrhaphy as a Treatment of Joint Instability Table of Contents Policy: Commercial Coding Information Information Pertaining to All Policies
1 Medical Policy Management of Obstructive Sleep Apnea (OSA) using Auto-Titrating Positive Airway Pressure (APAP) and Continuous Positive …
Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Reach for your fitness goals and get some cash back Aetna Fitness Reimbursement Program
Before submitting a Understanding/Salary Resolution for this County Staff Development Application for Taxable/Non-Taxable Reimbursement Form Instructions
Oxford® Sweat Equity Program Reimbursement Form Please Print Member name: _____ Street address: _____ ...