What types of policy changes does Premera Blue Cross issue?

Premera Blue Cross regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Premera Blue Cross update its policies?

Premera Blue Cross typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Premera Blue Cross policy changes are tracked here?

This page currently tracks 25 documented Premera Blue Cross policy changes. New items are added as they are identified.

What should I do when Premera Blue Cross changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Premera Blue Cross Policy Changes & Prior Auth Updates

We track 25 documented policy changes from Premera Blue Cross across AK, WA. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Premera Blue Cross notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Premera Blue Cross updates automatically.

Medium impact
Medical Policy and Coding Updates - July 2024
Premera Blue Cross·Effective Oct 20, 2024
Premera updated multiple Carelon Medical Benefits Management clinical guidelines effective October 20, 2024, covering radiology, cardiology, genetic testing, radiation oncology, and sleep medicine. These updates expand coverage criteria for certain imaging studies (including Alzheimer's MRI/PET scans), genetic testing, and sleep disorder treatments while clarifying documentation requirements and removing some coverage options.
Medium impact
Medical Policy and Coding Updates - August 2024
Premera Blue Cross·Effective Oct 20, 2024
Carelon Medical Benefits Management (formerly AIM Specialty Health) is updating clinical appropriateness guidelines across multiple specialties including radiology, cardiology, genetic testing, radiation oncology, and sleep medicine. The updates expand coverage criteria for certain procedures like Alzheimer's imaging, echocardiography monitoring, and genetic testing while restricting others.
High impact
Medical Policy and Coding Updates - September 2024
Premera Blue Cross·Effective Oct 20, 2024
Premera Blue Cross has added site of service reviews for multiple IV infusion drugs and biologics used to treat arthritis, inflammatory bowel disease, and autoimmune conditions. These drugs will now require review when administered in inpatient settings, with changes effective December 5, 2024, November 1, 2024, and October 20, 2024 depending on the specific medication.
High impact
Medical Policy and Coding Updates - October 2024
Premera Blue Cross·Effective Jan 3, 2025
Premera HMO is implementing significant prior authorization and coverage changes for multiple drug categories effective January 3, 2025, including new step therapy requirements for cancer drugs (HER2 inhibitors moving biosimilars to first-line), stricter criteria for asthma medications (IL-5 inhibitors requiring higher eosinophil counts), and new coverage criteria for multiple sclerosis treatments. These changes will require prior authorization documentation and affect billing for oncology, pulmonology, and neurology practices.
High impact
Medical Policy and Coding Updates - November 2024
Premera Blue Cross·Effective Jan 3, 2025
Premera updated medical necessity criteria for multiple drug policies effective January 3, 2025 and February 7, 2025, changing preferred/non-preferred drug tiers and adding new coverage criteria for several specialty medications including oncology drugs, biologics, and GnRH analogs.
Medium impact
Medical Policy and Coding Updates - December 2024
Premera Blue Cross·Effective Jan 3, 2025
Premera Blue Cross implemented multiple policy updates with staggered effective dates from January 3 to March 5, 2025, affecting medical necessity criteria, drug coverage, and prior authorization requirements across various specialties including surgical lymphedema treatment, oncology drugs, and specialty medications. Most significantly, several medications now require trial and failure of preferred alternatives before coverage approval.
Medium impact
Medical Policy and Coding Updates - January 2025
Premera Blue Cross·Effective Apr 20, 2025
Premera Blue Cross updated their medical policies for hybrid closed-loop insulin delivery systems for type 2 diabetes and made extensive changes to Carelon Medical Benefits Management guidelines for radiology imaging and genetic testing, with expanded criteria for various cancer screenings and genetic tests.
Medium impact
Medical Policy and Coding Updates - February 2025
Premera Blue Cross·Effective Apr 20, 2025
Premera Blue Cross updated multiple medical policies effective April 20 and May 6, 2025, including new coverage for carpal tunnel release surgery, expanded genetic testing criteria, updated drug policies for testosterone products and specialty medications, and revised radiology imaging guidelines through Carelon Medical Benefits Management.
High impact
Medical Policy and Coding Updates - March 2025
Premera Blue Cross·Effective Apr 20, 2025
Premera Blue Cross updated multiple medical policies affecting pharmacy coverage, diagnostic testing, and surgical procedures with staggered effective dates from April to July 2025. Key changes include new prior authorization requirements, preferred drug tier changes, and coverage determinations for various treatments including asthma medications, genetic testing, and imaging guidelines.
High impact
Medical Policy and Coding Updates - April 2025
Premera Blue Cross·Effective Apr 20, 2025
Multiple policy updates effective at various dates from April to August 2025, including new drugs for severe asthma, updated genetic testing guidelines, new medical necessity criteria for various treatments, and changes to pharmaceutical coverage tiers. Key changes include updated criteria for genetic testing, new policies for carpal tunnel surgery and atrial fibrillation treatment, and medication tier changes.
Medium impact
Medical Policy and Coding Updates - May 2025
Premera Blue Cross·Effective May 1, 2025
Premera Blue Cross has released comprehensive medical and pharmacy policy updates for May 2025, including new genetic testing guidelines, updated drug coverage criteria, and new investigational determinations. Key changes include updated criteria for various specialty medications, new policies for genetic testing procedures, and coverage updates for biologic therapies across multiple therapeutic areas.
Medium impact
Medical Policy and Coding Updates - June 2025
Premera Blue Cross·Effective Jun 1, 2025
Premera Blue Cross has updated multiple medical and pharmacy policies effective June-September 2025, including new coverage criteria for severe asthma treatments, genetic testing guidelines, atopic dermatitis medications, and various drug therapy protocols. Key changes include new medical necessity criteria for several specialty medications and updated prior authorization requirements.
High impact
Medical Policy and Coding Updates - July 2025
Premera Blue Cross·Effective Nov 15, 2025
This policy updates Carelon MBM Clinical Appropriateness Guidelines for Radiology and Genetic Testing effective November 15, 2025. Key changes include expanded criteria for brain MRI, simplified extremity imaging requirements, updated cardiac imaging guidelines, and broadened genetic testing criteria for various cancers.
High impact
Medical Policy and Coding Updates - August 2025
Premera Blue Cross·Effective Nov 15, 2025
Starting January 1, 2026, advanced imaging services will require site of care review through Carelon Medical Benefits Management, with specific criteria for when hospital outpatient departments are medically necessary. Multiple radiology and genetic testing guidelines are also being updated effective November 15, 2025.
High impact
Medical Policy and Coding Updates - September 2025
Premera Blue Cross·Effective Nov 15, 2025
Premera Blue Cross updated multiple policies effective November 15, 2025 through January 1, 2026, including new site of care reviews for advanced imaging through Carelon Medical Benefits Management, updated botulinum toxin criteria, and new coverage for negative pressure wound therapy devices. The changes also include extensive updates to radiology appropriateness guidelines across multiple imaging categories.
High impact
Medical Policy and Coding Updates - October 2025
Premera Blue Cross·Effective Jan 2, 2026
Premera Blue Cross updated medical necessity criteria and preferred drug formularies across multiple therapeutic areas, with major changes to preferred status for biosimilar medications including adalimumab, infliximab, and rituximab products. Most changes require step therapy with preferred products before accessing non-preferred alternatives.
High impact
Medical Policy and Coding Updates - November 2025
Premera Blue Cross·Effective Jan 1, 2026
Premera Blue Cross has issued extensive medical policy updates effective in multiple phases from January 1, 2026 through February 6, 2026. The changes include new coverage policies for surgical procedures, significant updates to drug formulary preferences requiring step therapy with preferred products, and new medical necessity criteria across multiple specialties including oncology, gastroenterology, orthopedics, and autoimmune conditions.
High impact
Medical Policy and Coding Updates - December 2025
Premera Blue Cross·Effective Jan 2, 2026
Premera Blue Cross updated medical necessity criteria and coverage policies for multiple conditions including new policies for shoulder procedures, hernia repairs, and various drug formulary changes. Key changes include updated preferred drug lists for biologics, new coverage for shoulder arthroscopy/arthrotomy, and revised criteria for immune checkpoint inhibitors with staggered effective dates from January 2 through March 4, 2026.
High impact
Medical Policy and Coding Updates - January 2026
Premera Blue Cross·Effective Jan 2, 2026
Premera Blue Cross updated multiple medical policies for 2026 with staggered effective dates from January 2 through April 8, 2026. Key changes include new coverage policies for cardiac procedures, shoulder surgeries, hernia repairs, and significant updates to preferred/non-preferred drug formularies affecting biologics and specialty medications.
High impact
Medical Policy and Coding Updates - February 2026
Premera Blue Cross·Effective Feb 6, 2026
Premera Blue Cross has implemented multiple policy updates across various specialties effective February-April 2026, including new policies for electrophysiology studies, shoulder procedures, gastroesophageal reflux surgery, and updated criteria for cardiac monitoring, oncology drugs, and specialty medications. These changes affect medical necessity criteria, prior authorization requirements, and site of service reviews for ambulatory surgery centers.
High impact
Medical Policy and Coding Updates - March 2026
Premera Blue Cross·Effective Mar 1, 2026
Premera Blue Cross has implemented multiple policy updates for March 2026, including new medical necessity criteria for carpal tunnel release surgery (simplified to require either electrodiagnostic testing OR CTS-6 score >12), new coverage for deep brain stimulation for treatment-resistant OCD, and expanded radiation therapy programs. Several procedures now require ASC site-of-service reviews and new drug coverage criteria have been added.
High impact
Medical Policy and Coding Updates - April 2026
Premera Blue Cross·Effective Apr 1, 2026
Premera Blue Cross has updated multiple medical and pharmacy policies with new prior authorization requirements, site of service reviews, and coverage criteria changes. Key changes include new drugs requiring site of service administration review, updated criteria for various treatments including bariatric surgery and shoulder arthroscopy, and new coverage for implantable loop recorders.
High impact
Medical Policy and Coding Updates - May 2026
Premera Blue Cross·Effective May 1, 2026
Premera Blue Cross updated multiple medical and pharmacy policies effective between May 1, 2026 and August 7, 2026, including new site of service reviews for various infusion drugs, updated medical necessity criteria for immune globulin therapy and denosumab products, and new policies for prostate artery embolization and hematopoietic cell transplantation.
High impact
Medical Policy and Coding Updates - June 2026
Premera Blue Cross·Effective Sep 19, 2026
Multiple Carelon Medical Benefits Management clinical guidelines are being updated effective September 19, 2026, affecting radiology imaging criteria, sleep disorder management, and genetic testing requirements. Key changes include expanded imaging allowances for extremities and spine conditions, updated sleep study criteria, and revised genetic testing limitations.
High impact
Medical Policy and Coding Updates - June 2026
Premera Blue Cross·Effective Sep 19, 2026
Carelon Medical Benefits Management has updated clinical appropriateness guidelines for radiology, sleep disorder management, and genetic testing, expanding coverage criteria for many imaging studies and diagnostic tests. Multiple policies also updated medical necessity criteria for procedures like negative pressure wound therapy and orthognathic surgery.

Premera Blue Cross in AK Premera Blue Cross in WA Premera Blue Cross: Allergy & Immunology Premera Blue Cross: Cardiology Premera Blue Cross: Dermatology Premera Blue Cross: Diagnostic Imaging All payers

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Medical Policy and Coding Updates - July 2024

Medical Policy and Coding Updates - August 2024

Medical Policy and Coding Updates - September 2024

Medical Policy and Coding Updates - October 2024

Medical Policy and Coding Updates - November 2024

Medical Policy and Coding Updates - December 2024

Medical Policy and Coding Updates - January 2025

Medical Policy and Coding Updates - February 2025

Medical Policy and Coding Updates - March 2025

Medical Policy and Coding Updates - April 2025

Medical Policy and Coding Updates - May 2025

Medical Policy and Coding Updates - June 2025

Medical Policy and Coding Updates - July 2025

Medical Policy and Coding Updates - August 2025

Medical Policy and Coding Updates - September 2025

Medical Policy and Coding Updates - October 2025

Medical Policy and Coding Updates - November 2025

Medical Policy and Coding Updates - December 2025

Medical Policy and Coding Updates - January 2026

Medical Policy and Coding Updates - February 2026

Medical Policy and Coding Updates - March 2026

Medical Policy and Coding Updates - April 2026

Medical Policy and Coding Updates - May 2026

Medical Policy and Coding Updates - June 2026

Medical Policy and Coding Updates - June 2026