CommercialCoverageMedium impact
Medical Policy and Coding Updates - August 2023
Premera Blue Cross·WA, AK · Orthopedics, Cardiothoracic Surgery, Oncology +4 more·Medical Policy
Effective date
Sep 1, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross has implemented multiple policy updates for Washington and Alaska affecting drug coverage, surgical procedures, and medical necessity criteria. Key changes include new coverage for Zilretta injections for knee osteoarthritis, updated criteria for bariatric surgery and cardiac procedures, and revised pharmacy policies for various specialty medications.
Action Required
By September 1, 2023: Billing teams must update prior authorization requirements for Zilretta (triamcinolone acetonide) injections limiting coverage to once per knee per lifetime for osteoarthritis. Update systems to reflect new medical necessity criteria for bariatric surgery GERD indications and revised maze procedure coverage criteria. Verify patient eligibility and documentation requirements for newly covered oncology drugs including Xgeva and updated specialty medications.