CommercialCoverageHigh impact
Medical Policy and Coding Updates - April 2024
Premera Blue Cross·WA, AK · Oncology, Radiology, Neurology +4 more·Medical Policy
Effective date
Jul 4, 2024
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies with new coverage criteria for genetic testing, radiation therapy, advanced imaging, and several pharmaceutical treatments. Key changes include expanded genetic testing coverage for hereditary cancers, updated radiation therapy guidelines, new imaging criteria for various conditions, and added coverage for specific medications like Qutenza and Briumvi.
Action Required
By July 4, 2024: Billing teams must review and update prior authorization requirements for genetic testing services, radiation therapy procedures, and advanced imaging studies. Update billing software to reflect new medical necessity criteria for Qutenza (capsaicin), Briumvi (ublituximab-xiiy), and Skyrizi (risankizumab-rzaa). Ensure documentation requirements meet updated Carelon Medical Benefits Management guidelines for genetic testing, radiation therapy, and imaging services. Contact Carelon at MedicalBenefitsManagement.guidelines@Carelon.com for specific guideline questions.