CommercialPrior AuthMedium impact
Medical Policy and Coding Updates - June 2023
Premera Blue Cross·WA · Hematology, Oncology, Nephrology +2 more·Medical Policy
Effective date
Jun 1, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross has updated multiple medical and pharmacy policies with new coverage criteria for various drugs and procedures, including new prior authorization requirements for intravenous iron replacement products. The updates include new medications for cancer treatment, migraine management, multiple sclerosis, and other conditions with specific medical necessity criteria.
Action Required
By June 1, 2023: Billing team must update system to require prior authorization for intravenous iron replacement product codes J1437, J1439, Q0138, and Q0139. These codes now require review for medical necessity and prior authorization. Update billing software to flag these codes for prior auth verification before claim submission.