CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - June 2024
Premera Blue Cross·WA · Oncology, Hematology, Neurology +6 more·Medical Policy
Effective date
Aug 2, 2024
We identified it
Jun 18, 2026
Summary
Premera Blue Cross released comprehensive June 2024 policy updates affecting multiple specialties with new prior authorization requirements, coverage changes for genetic testing, and updated medical necessity criteria for various drugs and treatments. Key changes include new complement inhibitor policies, expanded genetic testing guidelines, and updated site of service reviews for specialty medications.
Action Required
By August 2, 2024: Billing teams must update systems to require prior authorization for complement inhibitor treatments and genetic testing services. Update medical necessity criteria for multiple drug therapies including Brukinsa, Rybrevant, and Nexavar. Implement site of service review requirements for infusion drugs (J2327, J2329) and update prosthetic device coding requirements (L5969, L5973). Add investigational review flags for leadless cardiac pacemaker codes (0795T-0803T) and digital therapeutics (S9002). Claims submitted without proper authorization or updated criteria will face denials.