All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - April 2018
Premera Blue Cross·WA · Gastroenterology, Oncology, Hematology +6 more·Medical Policy
Effective date
Apr 1, 2018
We identified it
Jun 18, 2026
Summary
Multiple policy updates with varying effective dates from March to July 2018, including new prior authorization requirements for CAR T-cell therapies and artificial hearts, several codes moved to investigational status, and new coverage criteria for rare disease drugs and opioid management.
Action Required
By April 1, 2018: Billing team must update system to require prior authorization for CAR T-cell therapy (Q2041), artificial heart procedures (33927, 33928, 33929), biosimilar infliximab injections (Q5103, Q5104), and whole exome sequencing (0036U). By July 5, 2018: Mark codes 43201, 43236, 43257 as investigational for gastroesophageal reflux procedures. Update encounter forms and train providers on new prior auth requirements. Claims without proper authorization will be denied.