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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Physical Therapy, Occupational Therapy, Orthopedics +16 moreHigh impact

Medical Policy and Coding Updates - July 2025

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

Summary

Effective October 3, 2025, codes for several drugs, including J0491, J0517, J0638, J2182, J2351, J2356, J2357, J3032, J3111, J3241, J9024, J9272, J9332 and J9334, now require review for site of service, in addition to the existing medical necessity and prior authorization review. Physical and occupational therapy services for individual plans require prior authorization starting with the seventh visit, effective July 3, 2025. Effective September 5, 2025, non-individual plans use InterQual criteria to determine the appropriate level of care for all planned procedures.

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What to do

Action · 4 steps
01Already effective October 3, 2025: For the drug codes listed as now requiring site of service review, including J0491, J9332, J9334, J3032, J3241, J0517, J2182, J9024, J9173, J9272, J9289, J9622, J0638, J2351, J3111, J2356 and J2357, site of service review applies in addition to medical necessity and prior authorization review.
02Already effective July 3, 2025: For individual plans, get prior authorization for physical and occupational therapy services starting with the seventh visit.
03The initial six visits do not require review, and these services continue to be reviewed using InterQual criteria.
04Already effective September 5, 2025: For non-individual plans, InterQual criteria determine the appropriate level of care for planned procedures, and prior authorization for all inpatient hospital care continues to be required.

Codes mentioned

C1721C1722C1824C1882C1895C1896C18993321633217332303323133240332493327033271932609328793289J0364J1748C9739C97405244152442J3111J0517J0638J9173J9272J2182J2351J9622J0491J9022J9024J3241J2356J3032J9332J9334J2357J1747C1763S0145J0248J1201J2278J3396L688269719J0893J0630936559365693657Q4368Q4369Q4370Q4371Q4372Q4373Q4375Q4376Q4377Q4378Q4379Q4380Q4382C9174J9276J9382Q2058J3391J9275J9289J1326J9341J9174J7172J7356Q9997Q5098Q5099Q5100Q5137Q5138Q9996Q9998Q9999312333123531240A6610E0201E1022E1023C8005

Original notice

Medical Policy and Coding Updates - July 2025
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 - August 2025HighNo effective date · Medical PolicyMedical Policy and Coding Updates - September 2025HighEffective Jan 1, 2026 · Medical PolicyMedical Policy and Coding Updates - October 2025HighEffective Jan 2, 2026 · Medical PolicyMedical Policy and Coding Updates - November 2025HighEffective Feb 6, 2026 · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesPhysical TherapyOccupational TherapyOrthopedicsPharmacyNeurologyRheumatologyDermatologyGastroenterologyPulmonologyCardiologyOB-GYNUrologyENT (Ear, Nose & Throat)GeneticsOncologyHematologyRadiologyPediatricsEndocrinologyCode C1721Code C1722Code C1824Code C1882Code C1895Code C1896Code C1899Code 33216Code 33217Code 33230Code 33231Code 33240Code 33249Code 33270Code 33271Code 93260Code 93287Code 93289Code J0364Code J1748Code C9739Code C9740Code 52441Code 52442Code J3111Code J0517Code J0638Code J9173Code J9272Code J2182Code J2351Code J9622Code J0491Code J9022Code J9024Code J3241Code J2356Code J3032Code J9332Code J9334Code J2357Code J1747Code C1763Code S0145Code J0248Code J1201Code J2278Code J3396Code L6882Code 69719Code J0893Code J0630Code 93655Code 93656Code 93657Code Q4368Code Q4369Code Q4370Code Q4371Code Q4372Code Q4373Code Q4375Code Q4376Code Q4377Code Q4378Code Q4379Code Q4380Code Q4382Code C9174Code J9276Code J9382Code Q2058Code J3391Code J9275Code J9289Code J1326Code J9341Code J9174Code J7172Code J7356Code Q9997Code Q5098Code Q5099Code Q5100Code Q5137Code Q5138Code Q9996Code Q9998Code Q9999Code 31233Code 31235Code 31240Code A6610Code E0201Code E1022Code E1023Code C8005

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