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Medical Policy and Coding Updates - March 2026
Premera Blue Cross·WA · Orthopedics, Neurosurgery, Gastroenterology +4 more·Medical Policy
Effective date
Mar 1, 2026
We identified it
Jun 16, 2026
Summary
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.
Action Required
By March 1, 2026: Update billing system and encounter forms to reflect new carpal tunnel release criteria requiring either electrodiagnostic testing OR CTS-6 score >12. Add deep brain stimulation for OCD to covered procedures when criteria are met. Update ASC site-of-service review requirements for carpal tunnel release, UGI endoscopy, and implantable loop recorders. Verify prior authorization requirements for new drug therapies including Daybue Stix, Zycubo, and Forzinity. Claims may be denied without proper documentation of updated medical necessity criteria.