All PlansCoverageMedium impact
Medical Policy and Coding Updates - August 2019
Premera Blue Cross·WA · Orthopedics, Radiology, Oncology +5 more·Medical Policy
Effective date
Aug 1, 2019
We identified it
Jun 18, 2026
Summary
Multiple medical policy updates effective at different dates including new criteria for joint replacement at designated centers (Jan 2020), updated imaging guidelines (Nov 2019), and various coverage changes for procedures like peripheral nerve stimulation, osteoporosis treatments, and surgical devices (Aug-Nov 2019).
Action Required
By January 1, 2020: Billing team must verify Total Joint Replacement Centers of Excellence Program eligibility for knee/hip replacement patients and ensure procedures are performed at designated centers. By November 10, 2019: Update prior authorization processes for advanced imaging per new AIM Specialty Health guidelines - requires verification of conservative treatment requirements for TMJ, sinusitis imaging criteria, and updated PET scan appropriateness. By August 1, 2019: Stop billing for investigational procedures including handheld radiofrequency spectroscopy (MarginProbe), phrenic nerve stimulation, and peripheral nerve stimulators as these will be denied.