2025 Blue Cross and Blue Shield Service Benefit Plan - FEP Blue Focus
Section 5(b). Surgical and Anesthesia Services Provided by Physicians and Other Healthcare Professionals
Surgical Procedures

 

Note: We state whether or not the calendar year deductible applies for each benefit listed in this section.

Benefit Description

Surgical Procedures
A comprehensive range of services, such as:
 
  • Operative procedures
     
  • Assistant surgeons/surgical assistance if required because of the complexity of the surgical procedures
     
  • Treatment of fractures and dislocations, including casting
     
  • Normal pre- and post-operative care by the surgeon
     
  • Corneal transplant
     
  • Correction of amblyopia and strabismus
     
  • Colonoscopy, with or without biopsy
    Note: Preventive care benefits apply to the professional charges for your first covered colonoscopy of the calendar year (see Section 5(a)). We provide benefits as described here for subsequent colonoscopy procedures performed by a professional provider in the same year.
     
  • Endoscopic procedures
     
  • Injections
     
  • Biopsy procedures
     
  • Removal of tumors and cysts
     
  • Correction of congenital anomalies
     
  • Treatment of burns
     
  • Male circumcision
     
  • Insertion of internal prosthetic devices. See Section 5(a), Orthopedic and Prosthetic Devices, and “Other hospital services and supplies” in Section 5(c), Inpatient Hospital, for our coverage for the device.
     
  • Procedures to treat severe obesity when you meet the clinical criteria listed in our medical policy at www.fepblue.org/legal/policies-guidelines for any initial and subsequent surgery (prior approval required).
     
Notes:
  • For surgical family planning procedures, see Family Planning in Section 5(a).
     
  • Surgical services to treat severe obesity must be performed in a Blue Distinction Center for Comprehensive Bariatric Surgery.
     
  • When multiple surgical procedures that add time or complexity to patient care are performed during the same operative session, the Local Plan determines our allowance for the combination of multiple, bilateral, or incidental surgical procedures. Generally, we will allow a reduced amount for procedures other than the primary procedure.
     
  • We do not pay extra for “incidental” procedures (those that do not add time or complexity to patient care).
     
  • When unusual circumstances require the removal of casts or sutures by a physician other than the one who applied them, the Local Plan may determine that a separate allowance is payable


You Pay
Preferred: 30% of the Plan allowance (deductible applies)

Non-preferred (Participating/Non-participating): You pay all charges

 

Benefit Description

Not covered:
 
  • Reversal of voluntary sterilization
     
  • Services of a standby physician
     
  • Routine surgical treatment of conditions of the foot (See Section 5(a), Foot care.)
     
  • Cosmetic surgery
     
  • LASIK, INTACS, radial keratotomy, and other refractive surgery
     
  • Surgeries related to sexual inadequacy (except surgical placement of penile prostheses to treat erectile dysfunction and gender affirming surgeries specifically listed as covered)
     
  • Reversal of gender affirming surgery
     
  • Surgical procedures for the treatment of severe obesity when performed outside a Blue Distinction Center


You Pay
All charges