CommercialCoverageMedium impact
Medical Policy and Coding Updates - February 2025
Premera Blue Cross·WA · Orthopedics, Radiology, Endocrinology +6 more·Medical Policy
Effective date
Apr 20, 2025
We identified it
Jun 16, 2026
Summary
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.
Action Required
By April 20, 2025: Review and update prior authorization workflows for radiology imaging services per new Carelon Medical Benefits Management guidelines. By May 6, 2025: Update billing protocols for carpal tunnel release surgery (policy 7.01.595) to ensure medical necessity criteria documentation. Billing teams should verify testosterone product coverage criteria updates for Aveed and Testopel, and confirm site of service requirements for Tyenne (tocilizumab-aazg) IV infusions.