CommercialCoverageHigh impact
Medical Policy and Coding Updates - March 2023
Premera Blue Cross·WA · Psychiatry, Radiology, Cardiology +5 more·Medical Policy
Effective date
Mar 1, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies effective March-May 2023, including expanded ABA therapy coverage criteria, new imaging guidelines for advanced procedures, updated cardiac imaging requirements, and added coverage for rare disease drugs. Several new medical necessity criteria and documentation requirements were implemented across multiple specialties.
Action Required
By May 2, 2023: Billing teams must update ABA therapy authorization processes to reflect new medical necessity criteria including expanded provider types and revised treatment settings. By April 9, 2023: Update prior authorization requirements for advanced imaging procedures including CT coronary angiography, cardiac MRI, and radiation therapy per new Carelon Medical Benefits Management guidelines. Immediately: Add new rare disease drugs Mepsevii and Naglazyme to covered drug lists and implement site-of-service reviews. Update documentation templates to capture expanded diagnostic criteria and provider qualifications for ABA services.