CommercialCoverageHigh impact
Medical Policy and Coding Updates - November 2020
Premera Blue Cross·WA · Orthopedics, Cardiology, Neurology +8 more·Medical Policy
Effective date
Feb 5, 2021
We identified it
Jun 18, 2026
Summary
Multiple medical policies are being updated with revised coverage criteria and age requirements. Key changes include lowering age limits for artificial pancreas devices and cochlear implants, restricting knee arthroscopy coverage for degenerative tears, and updating drug coverage requirements with new prior authorization criteria.
Action Required
By February 5, 2021: Billing team must update prior authorization requirements and coverage criteria for multiple services including artificial pancreas devices (now age 6+), cochlear implants (now 9 months+), and knee arthroscopy procedures. Update system to flag degenerative meniscal tears as not covered unless functional impairment is documented. Review and update encounter forms for affected specialties. Claims not meeting new criteria will be denied.