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Medical Policy and Coding Updates - January 2025
Premera Blue Cross·WA, AK · Oncology, Radiology, Endocrinology +5 more·Medical Policy
Effective date
Apr 20, 2025
We identified it
Jun 16, 2026
Summary
Premera Blue Cross updated their medical policies for hybrid closed-loop insulin delivery systems for type 2 diabetes and made extensive changes to Carelon Medical Benefits Management guidelines for radiology imaging and genetic testing, with expanded criteria for various cancer screenings and genetic tests.
Action Required
Before April 20, 2025: Billing and prior authorization teams must review and update workflows for radiology imaging requests including oncologic imaging, abdominal/pelvic imaging, chest imaging, and genetic testing. Update prior authorization requirements for expanded genetic testing criteria including hereditary cancer testing, cardiac conditions, and carrier screening. Review artificial pancreas device systems policy 1.01.30 for type 2 diabetes coverage criteria.