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Medical Policy and Coding Updates - January 2023
Effective date
Apr 9, 2023
Identified
Jun 18, 2026
Summary
Many billing codes were added, changed or removed effective January 1, 2023 and January 6, 2023. Examples include J9314 under Folate Antimetabolites, which now requires medical necessity review and prior authorization, and 22860 for the lumbar artificial intervertebral disc, which now requires investigational review and prior authorization. Code 90870 under the InterQual criteria policy now requires medical necessity review and prior authorization effective January 6, 2023, and 27703 no longer requires review on that date.
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What to do
Action · 8 steps
01Already effective January 1, 2023: J9314 requires review for medical necessity and prior authorization under the Folate Antimetabolites policy.
0222860 requires review for investigational status and prior authorization under the lumbar artificial intervertebral disc policy.
0343290 and 43291 require review for investigational status under the bariatric surgery policy.
04C7516 through C7529, C7552 and C7553 require review for medical necessity under the coronary angiography policy.
05Already effective January 6, 2023: 90870 requires review for medical necessity and prior authorization under the InterQual criteria policy.
06Billing team: confirm prior authorization is in place for J9314, 22860 and 90870 before billing them.
0727703 no longer requires review.
08Check current applicability of these dates before acting on them.
Codes mentioned
Q4236Q4262Q4263Q4264228604329043291C7516C7517C7518C7519C7520C7521C7522C7523C7524C7525C7526C7527C7528C7529C7552C7553J93146972969730J9046J9048J9049C7507C7508C7504C7505J0225J23279897830469C1826C1827Q512681418814418144981451814569087027703C18496971569718J9037C1841C184230117C9142
Original notice
Medical Policy and Coding Updates - January 2023
premera.com · Always check the source before changing claims.
Related changes
See all Premera Blue Cross changes →Medical Policy and Coding Updates - January 2022MediumEffective Mar 13, 2022 · Medical PolicyMedical Policy and Coding Updates - December 2022MediumEffective Apr 9, 2023 · Medical PolicyMedical Policy and Coding Updates - November 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2022MediumEffective Dec 1, 2022 · Medical PolicyBrowse every Premera Blue Cross change in the policy list
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