CommercialPrior AuthMedium impact
Medical Policy and Coding Updates - June 2020
Premera Blue Cross·WA · Oncology, Pulmonology, Rheumatology +3 more·Medical Policy
Effective date
Sep 4, 2020
We identified it
Jun 18, 2026
Summary
Premera Blue Cross WA has implemented multiple policy updates including new drug coverage for cancer treatments, gout medication, and COVID-19 antibody testing. Several billing codes have been added or removed for prior authorization requirements, and some surgical procedures no longer require site-of-service reviews.
Action Required
By September 4, 2020: Billing team must update system to require prior authorization for codes J9145, G2082, and G2083. Remove prior authorization requirements for codes 97129, 97130, and 27445. Add medical necessity review requirements for codes 86328, 86769, and 0507T. Update encounter forms and billing software rules accordingly.