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Medical Policy and Coding Updates - February 2026
Premera Blue Cross·WA · Cardiology, Orthopedics, Gastroenterology +3 more·Medical Policy
Effective date
Feb 6, 2026
We identified it
Jun 16, 2026
Summary
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.
Action Required
Before February 6, 2026: Billing teams must update prior authorization workflows for newly covered procedures including electrophysiology studies (policy 2.02.517), shoulder arthroscopy and arthrotomy (policies 7.01.602, 7.01.605), gastroesophageal reflux surgery (policy 7.01.604), and implantable loop recorders (policy 2.02.510). Update system to flag ambulatory surgery center procedures for site of service reviews per policy 11.01.525. Pharmacy team must verify updated criteria for oncology drugs, antipsychotics, and weight management medications before approving claims. Claims submitted without meeting new medical necessity criteria will be denied.