All PlansPrior AuthMedium impact
Medical Policy and Coding Updates - October 2018
Premera Blue Cross·WA · Oncology, Cardiology, Pain Management +1 more·Medical Policy
Effective date
Oct 1, 2018
We identified it
Jun 18, 2026
Summary
This October 2018 Premera policy update includes multiple effective dates with key changes: new prior authorization requirements for CYP450 genetic testing codes (effective October 1, 2018), various investigational procedure determinations, radiation oncology guideline updates (effective January 28, 2019), and pharmacy policy revisions for specialty medications.
Action Required
By October 1, 2018: Billing team must update system to require prior authorization for CYP450 genetic testing codes 0028U, 0029U, 0031U, 0070U, 0071U, 0072U, 0073U, 0074U, 0075U, and 0076U. Update encounter forms to alert providers that these codes now require medical necessity review and prior authorization. Claims submitted without prior auth will be denied.