All PlansPrior AuthMedium impact
Medical Policy and Coding Updates - May 2018
Premera Blue Cross·WA · ENT (Ear, Nose & Throat), Gastroenterology, Ophthalmology +1 more·Medical Policy
Effective date
May 1, 2018
We identified it
Jun 18, 2026
Summary
Multiple policy changes effective between May-August 2018 including new prior authorization requirements, coverage changes for various procedures, and coding updates. Key changes include new prior auth for orthoptic training (92065), auditory devices (L8694), and coverage determinations for several investigational procedures.
Action Required
By May 1, 2018: Billing team must update system to require prior authorization for CPT 92065 (orthoptic training) and HCPCS L8694 (auditory osseointegrated device). Remove prior auth requirements for codes J3520, 86353, 88348, A9582, 0100T, A4638, and E2120. Update billing rules to mark CPT codes 43201, 43236, and 43257 as investigational for gastroesophageal reflux treatments effective July 5, 2018.