All PlansCoverageMedium impact
Medical Policy and Coding Updates - January 2019
Premera Blue Cross·WA · Neurosurgery, Orthopedics, Oncology +1 more·Medical Policy
Effective date
Feb 1, 2019
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective January 2019 including new coverage criteria for cervical spine surgeries, hereditary angioedema treatments, and various genetic testing policies being archived and moved to AIM Specialty Health review. New CPT codes added for CAR-T cell therapy.
Action Required
By February 1, 2019: Update billing systems with new CAR-T therapy CPT codes 0537T, 0538T, and 0539T marked as non-covered services. Review cervical spine surgery billing for updated coverage criteria under policy 7.01.560. Verify genetic testing claims are being routed to AIM Specialty Health for review instead of using archived policies. Update prior authorization workflows for hereditary angioedema medications based on medical vs pharmacy benefit coverage.