All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - July 2018
Premera Blue Cross·WA · Orthopedics, Oncology, Nephrology +7 more·Medical Policy
Effective date
Jul 1, 2018
We identified it
Jun 18, 2026
Summary
Comprehensive medical policy updates including new prior authorization requirements for multiple procedures and genetic tests, coverage changes for orthognathic surgery and vision therapy, and several new billing codes effective at various dates from July through October 2018.
Action Required
By July 1, 2018: Billing team must update system to require prior authorization for codes 0045U, 29867, Q5105, Q5106, 0060U, and Q9995. By August 3, 2018: Add prior auth requirements for auditory brainstem implant services. By October 5, 2018: Update orthognathic surgery criteria to require AHI ≥30 and 90-day PAP trial documentation. Update encounter forms and train staff on new genetic testing investigational designations. Claims without proper authorization will be denied.