CommercialCoverageHigh impact
Medical Policy and Coding Updates - February 2023
Premera Blue Cross·WA · Psychiatry, Radiology, Cardiology +3 more·Medical Policy
Effective date
Feb 18, 2023
We identified it
Jun 18, 2026
Summary
Premera updated multiple medical policies including expanded ABA therapy coverage criteria, revised AIM Specialty Health imaging guidelines for advanced imaging approvals, new radiation oncology standards, and added coverage for rare disease drugs. The changes affect prior authorization requirements and coverage criteria across multiple specialties with staggered effective dates from February through May 2023.
Action Required
By February 18, 2023: Update prior authorization processes for genetic testing per new AIM guidelines. By March 1, 2023: Add Mepsevii and Naglazyme to covered drug lists and update infusion site of service requirements. By April 9, 2023: Revise imaging prior auth criteria for cardiac MRI, CT coronary angiography, and advanced imaging per updated AIM guidelines. By May 2, 2023: Update ABA therapy authorization processes to reflect expanded coverage criteria including new provider types and treatment settings. Billing team must update system rules and notify providers of documentation changes to prevent claim denials.