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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Orthopedics, Cardiology, Gastroenterology +9 moreHigh impact

Medical Policy and Coding Updates - April 2026

Effective date
Not stated in the notice
Identified
Jun 16, 2026

Summary

Premera Washington policy changes carry effective dates from April 1, 2026 through July 2, 2026, and all of those dates had passed as of 2026-11-05. Many listed codes now require review for medical necessity and prior authorization, and several services now require review for site of service, including Upper Gastrointestinal Endoscopy, Carpal Tunnel Release Surgical Treatments, and Shoulder Arthroscopy in Adults. Other changes mark specific procedures as investigational or not medically necessary, add or remove criteria for drugs, and add quantity limits for some medications.

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What to do

Action · 4 steps
01Already effective April 1, 2026 through July 2, 2026: Check current applicability of these Washington Premera changes before billing, because this is .
02For codes the source says now require review for medical necessity and prior authorization, get prior authorization before scheduling the service.
03For services the source says now require review for site of service, such as Upper Gastrointestinal Endoscopy, Carpal Tunnel Release Surgical Treatments, and Shoulder Arthroscopy in Adults, review site of service before scheduling.
04Services the source describes as investigational or not medically necessary, such as prostate artery embolization for benign prostatic hyperplasia, are described in the source as not covered as medically necessary under these criteria.

Codes mentioned

37243G046515769C178970472C961033285E0616C176438230S2142Q4418Q4419Q4421Q4422Q4423Q4424Q4425Q4426Q4427Q4428Q4429Q4435Q4436Q4437Q4438Q4439A2040A2041A2042A2043A2044A2045J9601Q5161Q516264590J3404J900338232J9277J1553Q5103Q5156L2221J9183A8005A8006C1743G0680158771587815879C9309A9294C8007C8008C8009C8011C8012C8013C80104323543238432394324277436774377743877439298486472122867228682286922870C1821Q407429870C930729805298062980729819298202982129822298232982429825298262982729828J0223J9275J93332067020680230402304423101231052310623107231202313023410234122341523420234502345523460234622346523466235502355223585236152361623630236602367023680495914959349595496134961549617936099361393619936209362193622936249365393654J1437J1439Q0138Q0139

Original notice

Medical Policy and Coding Updates - April 2026
premera.com · Always check the source before changing claims.
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Related changes

See all Premera Blue Cross changes →
Medical Policy and Coding Updates - March 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - February 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - December 2025HighNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOrthopedicsCardiologyGastroenterologyOncologyNeurologyPulmonologyRheumatologyNephrologyHematologyPharmacyPlastic SurgeryUrologyCode 37243Code G0465Code 15769Code C1789Code 70472Code C9610Code 33285Code E0616Code C1764Code 38230Code S2142Code Q4418Code Q4419Code Q4421Code Q4422Code Q4423Code Q4424Code Q4425Code Q4426Code Q4427Code Q4428Code Q4429Code Q4435Code Q4436Code Q4437Code Q4438Code Q4439Code A2040Code A2041Code A2042Code A2043Code A2044Code A2045Code J9601Code Q5161Code Q5162Code 64590Code J3404Code J9003Code 38232Code J9277Code J1553Code Q5103Code Q5156Code L2221Code J9183Code A8005Code A8006Code C1743Code G0680Code 15877Code 15878Code 15879Code C9309Code A9294Code C8007Code C8008Code C8009Code C8011Code C8012Code C8013Code C8010Code 43235Code 43238Code 43239Code 43242Code 77436Code 77437Code 77438Code 77439Code 29848Code 64721Code 22867Code 22868Code 22869Code 22870Code C1821Code Q4074Code 29870Code C9307Code 29805Code 29806Code 29807Code 29819Code 29820Code 29821Code 29822Code 29823Code 29824Code 29825Code 29826Code 29827Code 29828Code J0223Code J9275Code J9333Code 20670Code 20680Code 23040Code 23044Code 23101Code 23105Code 23106Code 23107Code 23120Code 23130Code 23410Code 23412Code 23415Code 23420Code 23450Code 23455Code 23460Code 23462Code 23465Code 23466Code 23550Code 23552Code 23585Code 23615Code 23616Code 23630Code 23660Code 23670Code 23680Code 49591Code 49593Code 49595Code 49613Code 49615Code 49617Code 93609Code 93613Code 93619Code 93620Code 93621Code 93622Code 93624Code 93653Code 93654Code J1437Code J1439Code Q0138Code Q0139

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