Premera Blue CrossCommercial · Coverage · Medical Policy · WA · Orthopedics, Cardiothoracic Surgery, Oncology +3 moreMedium impact
Medical Policy and Coding Updates - August 2023
Effective date
Not stated in the notice
Identified
Jun 18, 2026
Summary
Effective September 1, 2023, Premera HMO added a new policy, Open and Thoracoscopic Approaches to Treat Atrial Fibrillation and Atrial Flutter (Maze and Related Procedures), 7.01.587, under which a maze or modified maze procedure performed on a non-beating heart during cardiopulmonary bypass is medically necessary, while stand-alone minimally invasive, off-pump maze procedures and hybrid ablation are investigational. Effective September 1, 2023, Zilretta was added for moderate to severe knee osteoarthritis pain in adults, and Xgeva was added effective August 4, 2023 for prevention of skeletal-related events in bone metastases from solid tumors and in multiple myeloma. Effective August 1, 2023, inpatient mental health treatment requires an initial psychiatric evaluation and a medical history and physical examination within one day after admission, and a nursing assessment upon admission followed by nursing staff observation 24 hours per day.
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01Already effective September 1, 2023: Stand-alone minimally invasive, off-pump maze procedures and hybrid ablation for atrial fibrillation or flutter are investigational, and the maze procedure is medically necessary only when performed on a non-beating heart during cardiopulmonary bypass.
02Already effective September 1, 2023: Zilretta is medically necessary for knee osteoarthritis pain in adults when criteria are met, with approval allowed once per knee per lifetime.
03Already effective August 1, 2023: Inpatient mental health treatment requires the initial psychiatric evaluation and medical history and physical examination within one day after admission, and a nursing assessment upon admission and nursing staff observation 24 hours per day.
04Already effective August 1, 2023: Code 0791T (eviCore managed) and code 0715T now require review for investigational status, and codes 79403, A9542 and A9543 no longer require review.
Codes mentioned
79403A9542A9543
Original notice
Medical Policy and Coding Updates - August 2023
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