CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - March 2022
Premera Blue Cross·WA · Radiology, Diagnostic Imaging, Gastroenterology +6 more·Medical Policy
Effective date
Mar 13, 2022
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective March 2022 include new prior authorization requirements for advanced imaging codes, new drug coverage policies with step therapy requirements, and removal of coverage for certain cancer treatments. Most significantly, several CPT codes now require AIM Specialty Health prior authorization for advanced imaging.
Action Required
By March 13, 2022: Billing team must update systems to require prior authorization through AIM Specialty Health for CPT codes 0042T, 0648T, 0649T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T for advanced imaging. Update encounter forms and notify providers that these codes now require prior auth or claims will be denied. Additionally, update prior auth requirements for wireless capsule endoscopy codes 91112 and 91113 effective March 1, 2022.