CommercialCoverageMedium impact
Medical Policy and Coding Updates - December 2022
Premera Blue Cross·WA · Cardiology, Radiology, Oncology +4 more·Medical Policy
Effective date
Apr 9, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple clinical guidelines effective February-April 2023, including changes to advanced imaging criteria, genetic testing requirements, gender transition surgery coverage, and new drug policies. Key changes include removed indications for certain cardiac imaging, updated genetic testing criteria, and expanded coverage for gender-affirming services.
Action Required
By April 9, 2023: Review and update prior authorization processes for advanced imaging (cardiac MRI, CT, PET scans), genetic testing panels, and gender transition services. Clinical staff should review updated medical necessity criteria for AIM Specialty Health guidelines to ensure proper documentation and authorization requests. Update billing workflows to reflect new drug coverage policies for rare diseases and iron replacement products effective March 1, 2023.