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Medical Policy and Coding Updates - August 2018
Premera Blue Cross·WA · Oncology, Pain Management, Cardiology +3 more·Medical Policy
Effective date
Aug 1, 2018
We identified it
Jun 18, 2026
Summary
Multiple medical and pharmacy policy updates effective August 1, 2018, with additional changes in October and November 2018. Key changes include new investigational designations for various procedures, updated prior authorization requirements for molecular cancer testing (CPT 81455), and revised criteria for orthognathic surgery and drug testing in pain management.
Action Required
By August 1, 2018: Update billing system to require prior authorization for CPT 81455 (molecular cancer panel testing). Mark CPT 0441T as investigational for cryoablation procedures. Review and update encounter forms for orthognathic surgery criteria changes effective October 5, 2018, and cardiac monitoring procedures effective November 2, 2018. Billing team should verify coverage policies before submitting claims for these codes to avoid denials.