All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - June 2018
Premera Blue Cross·WA, AK · Gastroenterology, Neurosurgery, Plastic Surgery +6 more·Medical Policy
Effective date
Aug 3, 2018
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective June-August 2018 including new prior authorization requirements for rare disease drugs and reconstructive breast surgery codes, updated coverage criteria for various medications, and coding changes for neurophysiology monitoring and gastroesophageal procedures.
Action Required
By August 3, 2018: Billing team must update systems to require prior authorization for rare disease drug codes (J0180, J0221, J1322, J1743, J1786, J3385) and reconstructive breast surgery codes (S2067, S2068). Update encounter forms to flag these codes for prior auth. Mark esophageal procedure codes (43201, 43236, 43257) as investigational/non-covered. Remove prior auth requirements for evoked potential codes (95925-95929, 95938-95939). Update pharmacy edits for new Testopel criteria and migraine prophylaxis coverage.