All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - May 2019
Premera Blue Cross·WA · Ophthalmology, ENT (Ear, Nose & Throat), Neurology +7 more·Medical Policy
Effective date
May 1, 2019
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical and pharmacy policies effective May through August 2019, with significant changes including new prior authorization requirements for amniotic membrane procedures, auditory implants, and migraine injections, plus coverage criteria updates for various specialty medications and treatments.
Action Required
By May 1, 2019: Billing team must update system to require prior authorization for CPT codes 65778, 65779, 92640, S2235, L8625, and J3030. Remove prior authorization requirement for L8695. Update Q-codes Q4137, Q4139, Q4148, Q4155, Q4156, Q4162, Q4163 from medical necessity to investigational review and remove prior auth requirements. Update Q-codes Q4176, Q4177, Q4178, Q4180, Q4181 to investigational status without prior auth. Review all affected specialty medication policies for updated criteria and age restrictions.