All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - February 2019
Premera Blue Cross·WA · Orthopedics, Neurosurgery, Ophthalmology +6 more·Medical Policy
Effective date
Feb 1, 2019
We identified it
Jun 18, 2026
Summary
Multiple medical and pharmacy policies updated with new prior authorization requirements, coverage changes, and billing code modifications. Key changes include new prior auth requirements for cervical spine surgeries, sacroiliac joint procedures moving from investigational to covered status, and updates to drug coverage criteria including new oncology medications.
Action Required
By February 1, 2019: Billing team must update system to require prior authorization for cervical spine surgery codes 22600, 63020, 63045, sacroiliac joint procedure code 27279, corneal collagen cross-linking code J2787, hereditary angioedema injection codes J0596-J0599, J1290, J1744, and HIV medication code J1746. Update encounter forms to alert providers of new prior auth requirements. Mark codes 54200 and 54205 as non-covered for Peyronie disease injections. Claims without proper authorization will be denied.