All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - June 2019
Premera Blue Cross·WA · Orthopedics, Oncology, Neurology +4 more·Medical Policy
Effective date
Jun 1, 2019
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective between June 1 and September 28, 2019, including new prior authorization requirements for imaging services, genetic testing, and various medications. Key changes include Q5111 code now requiring prior auth and updates to AIM clinical appropriateness guidelines for advanced imaging.
Action Required
By September 28, 2019: Billing team must update system to require prior authorization for Q5111 (pegfilgrastim-cbqv injections) and L6895 (external recharging systems). Update encounter forms and notify providers of new AIM Specialty Health prior authorization requirements for advanced imaging (brain, extremity, spine), genetic testing, and oncologic imaging including PET radiotracers. Review updated clinical appropriateness guidelines for all affected specialties.