All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - May 2022
Premera Blue Cross·WA · Oncology, Ophthalmology, Endocrinology +3 more·Medical Policy
Effective date
May 1, 2022
We identified it
Jun 18, 2026
Summary
Comprehensive policy updates with multiple effective dates affecting drug coverage, medical procedures, and billing codes. Key changes include new prior authorization requirements for rare disease drugs, updated medical necessity criteria for various medications, and coding changes for folate antimetabolites and amniotic products.
Action Required
By May 1, 2022: Billing team must update system to require prior authorization for J9304 (folate antimetabolites). Remove prior auth requirements for Q4145 and Q4168 (amniotic products) but add investigational review. Stop billing G0068 (chelation therapy) and 0546T (radiofrequency spectroscopy) as these no longer require review. Update drug formulary requirements for Tepezza, Nexviazyme, and other rare disease medications to reflect new medical necessity criteria.