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Medical Policy and Coding Updates - February 2024
Premera Blue Cross·WA · Oncology, Radiology, Cardiology +4 more·Medical Policy
Effective date
Apr 14, 2024
We identified it
Jun 18, 2026
Summary
Premera updated Carelon Medical Benefits Management clinical appropriateness guidelines effective April 14, 2024, affecting radiation therapy, advanced imaging, oncologic imaging, and genetic testing criteria. The policy also adds new medical necessity criteria for lymphoma treatments and transcranial magnetic stimulation.
Action Required
By April 14, 2024: Billing team must review and update prior authorization requirements for radiation therapy (IMRT for colon cancer, stereotactic body radiotherapy for hepatocellular carcinoma, external beam radiation therapy for prostate cancer), advanced imaging procedures (cardiac CT, echocardiography, abdominal/pelvic imaging, brain imaging, chest CT, oncologic imaging), genetic testing, monoclonal antibody treatments for lymphoma, and transcranial magnetic stimulation. Update billing system to reflect new clinical appropriateness guidelines and ensure proper documentation requirements are met. Contact Carelon at MedicalBenefitsManagement.Guidelines@Carelon.com for specific guideline questions.