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Premera Blue CrossCommercial · Coverage · Medical Policy · WA · Oncology, Rheumatology, Cardiology +5 moreMedium impact

Medical Policy and Coding Updates - September 2023

Effective date
Not stated in the notice
Identified
Jun 18, 2026

Summary

Effective September 1, 2023, Premera HMO added Laboratory Testing Investigational Services 2.04.520, under which all listed tests are investigational, and made dual chamber leadless pacemakers investigational under policy 2.02.515. Effective September 1, 2023, Premera HMO added Omisirge (omidubicel) medical necessity criteria for individuals 12 years of age and older with hematologic malignancies planned for umbilical cord blood transplantation, and added Olumiant (baricitinib) and Lifulo (ritlecitinib) for severe alopecia areata. Effective January 1, 2024, Trazimera (trastuzumab-qyyp) was updated to a second-line agent, Avsola (infliximab-axxq) was updated to a first-line product, and Inflectra (infliximab-dyyb) was updated to a second-line product, with the corresponding changes to Ruxience, Simponi Aria and pegfilgrastim products.

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What to do

Action · 5 steps
01Already effective September 1, 2023: Code J3304 for intraarticular corticosteroids and codes J9259 and J9328 for miscellaneous oncology drugs now require review for medical necessity and prior authorization, so obtain prior authorization for these services.
02Already effective September 1, 2023: Code 0112U for laboratory testing investigational services now requires review for investigational status.
03Already effective September 1, 2023: Maze procedure codes 33254, 33255, 33256, 33258, 33265 and 33266 now require review for investigational status.
04Already effective January 1, 2024: Avsola (IV) and Simponi Aria (IV) are first-line products for all indications, Inflectra (IV) is a second-line product for all indications, and Trazimera is a second-line agent for HER2 inhibitors.
05Already effective December 7, 2023: Temodar (temozolomide) IV is added for newly diagnosed glioblastoma and for refractory anaplastic astrocytoma in adult individuals who have progressed on nitrosourea and procarbazine, and dry needling of trigger points for myofascial pain is investigational.

Codes mentioned

J3304J9259J9328332543325533256332583326533266Q5123

Original notice

Medical Policy and Coding Updates - September 2023
premera.com · Always check the source before changing claims.
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Related changes

See all Premera Blue Cross changes →
Medical Policy and Coding Updates - July 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2023MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - December 2023MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2025HighNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOncologyRheumatologyCardiologyCardiothoracic SurgeryGastroenterologyHematologyOral & Maxillofacial SurgeryDermatologyCode J3304Code J9259Code J9328Code 33254Code 33255Code 33256Code 33258Code 33265Code 33266Code Q5123

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