CommercialCoverageHigh impact
Medical Policy and Coding Updates - January 2023
Premera Blue Cross·WA · Cardiology, Oncology, Radiology +5 more·Medical Policy
Effective date
Apr 9, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple clinical appropriateness guidelines effective April 9, 2023, affecting advanced imaging, cardiac testing, radiation oncology, genetic testing, and drug coverage. Key changes include expanded use of CT coronary angiography as first-line for CAD evaluation, new restrictions on MRI following nondiagnostic CT, and updated criteria for various imaging studies.
Action Required
By April 9, 2023: Clinical and billing teams must review all advanced imaging orders against updated AIM Specialty Health guidelines. Update prior authorization workflows for CT coronary angiography (now first-line for CAD), MRI restrictions following nondiagnostic CT, and new cardiac imaging criteria. Train providers on modified documentation requirements for stress testing, genetic testing limitations, and new drug coverage criteria including Pluvicto for prostate cancer and iron replacement products.