CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - September 2019
Premera Blue Cross·WA, AK · Cardiology, Ophthalmology, OB-GYN +10 more·Medical Policy
Effective date
Jan 1, 2020
We identified it
Jun 18, 2026
Summary
Premera Blue Cross Alaska updated 35 medical policies with new coverage criteria and coding requirements effective January 1, 2020. All listed procedures now require prior authorization and medical necessity review, with over 200 specific CPT/HCPCS codes affected across multiple specialties.
Action Required
Before January 1, 2020: Billing team must update prior authorization system to require medical necessity review for all listed CPT/HCPCS codes across 35 updated policies. Update billing software to flag these codes for prior auth requirements. Train staff on new coverage criteria for biofeedback, cardiac procedures, breast imaging, vaccines, and other affected services. Claims submitted without proper authorization will be denied.