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Medical Policy and Coding Updates - September 2024
Premera Blue Cross·WA · Rheumatology, Gastroenterology, Pulmonology +3 more·Medical Policy
Effective date
Oct 20, 2024
We identified it
Jun 16, 2026
Summary
Premera Blue Cross has added site of service reviews for multiple IV infusion drugs and biologics used to treat arthritis, inflammatory bowel disease, and autoimmune conditions. These drugs will now require review when administered in inpatient settings, with changes effective December 5, 2024, November 1, 2024, and October 20, 2024 depending on the specific medication.
Action Required
Before December 5, 2024: Billing team must implement site of service review processes for IV biologics including Cosentyx IV, Tofidence IV, Tyruko, Spevigo IV, and Alyglo when requested for inpatient administration. Update prior authorization workflows to include site of service verification for these medications. Before November 1, 2024: Add site of service reviews for Alpha-1 proteinase inhibitors (Aralast NP, Glassia, Prolastin-C, Zemaira) in inpatient settings. Failure to obtain proper site of service authorization may result in claim denials.