All PlansPrior AuthHigh impact
Medical Policy and Coding Updates - March 2018
Premera Blue Cross·WA · Orthopedics, Oncology, Gastroenterology +4 more·Medical Policy
Effective date
Mar 1, 2018
We identified it
Jun 18, 2026
Summary
This March 2018 policy update includes multiple changes with staggered effective dates: new prior authorization requirements for orthopedic cartilage procedures (CPT 27415, 27416, 28446, 29866) effective March 1, 2018, changes to rare disease drug coverage and surgical site preferences effective June 1, 2018, and removal of prior auth requirements for certain genetic tests. Several pharmacy policies were also revised with updated coverage criteria for various medications.
Action Required
By March 1, 2018: Billing team must update system to require prior authorization for orthopedic cartilage procedures CPT 27415, 27416, 28446, and 29866. Update encounter forms to alert providers of new prior auth requirement. By June 1, 2018: Update coverage policies for rare disease drugs and implement new surgical site of service review requirements. Remove prior authorization requirements for genetic test codes 0008M and 0015U effective immediately.