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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Oncology, Urology, Wound Care +1 moreHigh impact

Medical Policy and Coding Updates - July 2026

Effective date
Not stated in the notice
Identified
Jul 9, 2026

Summary

Premera's July 2026 Washington medical policy and coding update adds medical necessity review and prior authorization for bispecific antibodies (J9062) and denosumab products (Q5165, Q5166, Q5167, Q5171), effective July 1, 2026. Bioengineered skin and soft tissue substitutes (1044T through 1049T) are now considered investigational as of July 1, 2026, and upper gastrointestinal endoscopy (43235, 43238, 43239, 43242) now requires site of service review effective September 1, 2026. Other updates take effect on dates from August 7 through October 9, 2026, including radiology, sleep and genetic testing guidelines effective September 19, 2026.

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What to do

Action · 4 steps
01Already effective July 1, 2026: Bispecific antibodies (J9062) and denosumab products (Q5165, Q5166, Q5167, Q5171) now require review for medical necessity and prior authorization, so obtain prior authorization for these services under the plan's policy.
02Bioengineered skin and soft tissue substitutes billed under codes 1044T, 1045T, 1046T, 1047T, 1048T and 1049T are now considered investigational.
03Already effective September 1, 2026: Upper gastrointestinal endoscopy in adults (43235, 43238, 43239, 43242) now requires review for site of service, in addition to the existing medical necessity and prior authorization review.
04Already effective September 4, 2026: Pelvic floor stimulation as a treatment of urinary and fecal incontinence (E0740) is now considered investigational.

Codes mentioned

J9062Q5165Q5166Q5167Q517143235432384323943242E0740

Original notice

Medical Policy and Coding Updates - July 2026
premera.com · Always check the source before changing claims.
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Related changes

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Medical Policy and Coding Updates - August 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - May 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - June 2026HighNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2020MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOncologyUrologyWound CareGastroenterologyCode J9062Code Q5165Code Q5166Code Q5167Code Q5171Code 43235Code 43238Code 43239Code 43242Code E0740

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