CommercialCoverageMedium impact
Medical Policy and Coding Updates - November 2022
Premera Blue Cross·WA · Psychiatry, OB-GYN, Plastic Surgery +2 more·Medical Policy
Effective date
Feb 3, 2023
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies effective February 2023, including expanded genetic testing criteria, revised gender transition surgery coverage with new site-of-service reviews, reduced antidepressant trial requirements for Spravato, and expanded transcranial magnetic stimulation coverage. Most changes involve updated medical necessity criteria and documentation requirements.
Action Required
By February 3, 2023: Review and update prior authorization workflows for gender transition surgeries including hysterectomy, breast reduction, and rhinoplasty which now require site-of-service review. Update Spravato (esketamine) prior auth criteria to require only 3 failed antidepressants instead of 4. Review TMS billing for patients age 15+ with major depression (expanded from 18+). Update documentation templates to capture new genetic testing criteria and mental health recommendation letter requirements for gender transition services.