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CommercialPrior AuthHigh impact

Medical Policy and Coding Updates - April 2021

Premera Blue Cross·WA · Oncology, Hematology, Dermatology +8 more·Medical Policy
Effective date
Apr 1, 2021
We identified it
Jun 18, 2026
Days to comply
—

Summary

Multiple policy updates effective between April 1 and May 10, 2021, including new prior authorization requirements for several codes, expanded molecular testing criteria for cancer, new drug coverage policies, and updates to hereditary angioedema treatments. Key changes include new prior auth requirements for oncology drugs, genetic testing, and medical devices.

Action Required

Action needed
By May 10, 2021: Update billing system to require prior authorization for codes J9280, Q2053, C9074, E0270, A4575, K1014, J9349, 0565T, 0566T, J1427, S9055, G0460, S1091, K1020, 0242U, 0244U, 0245U. Remove prior auth requirements for codes 67909, C9073, C9072, J3333, C9069, C9070, J7401. Update encounter forms and staff training materials. Claims without proper authorization will be denied.

Affected Billing Codes

J9280
Q4108
Q2053
C9074
E0270
A4575
J1554
K1014
J9037
J9349
J1427
S9055
G0460
S1091
K1020
67909
C9073
C9072
J3333
C9069
C9070
J7401
81479
81313
81551

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