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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Genetics, Oncology, Psychiatry +10 moreMedium impact

Medical Policy and Coding Updates - November 2022

Effective date
Feb 18, 2023
Identified
Jun 18, 2026

Summary

Botulinum toxin codes J0585, J0586, J0587 and J0588 require review for medical necessity and prior authorization for dates of service starting on and after December 1, 2022, under the temporomandibular joint disorder and hyperhidrosis policies. Other changes revised criteria for genetic testing, Spravato, transcranial magnetic stimulation and gender transition surgery, and total ankle replacement (27703) no longer requires review.

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What to do

Action · 5 steps
01Already effective December 1, 2022: For dates of service starting on and after December 1, 2022, botulinum toxin codes J0585, J0586, J0587 and J0588 require review for medical necessity and prior authorization under the temporomandibular joint disorder and hyperhidrosis policies.
02Billing team: confirm prior authorization is in place for these codes before billing them.
03Already effective November 1, 2022: J9298 requires review for medical necessity and prior authorization under the Immune Checkpoint Inhibitors policy.
04Already effective January 6, 2023: 27703 no longer requires review under the total ankle replacement policy.
05Check current applicability of these dates before acting on them.

Codes mentioned

A2014A2015A2016A2017A2018A4596J9298J1551C9745J0585J0586J0587J05889087027703

Original notice

Medical Policy and Coding Updates - November 2022
premera.com · Always check the source before changing claims.
View original ↗

Related changes

See all Premera Blue Cross changes →
Medical Policy and Coding Updates - October 2022MediumEffective Dec 1, 2022 · Medical PolicyMedical Policy and Coding Updates - December 2022MediumEffective Apr 9, 2023 · Medical PolicyMedical Policy and Coding Updates - September 2022MediumEffective Dec 1, 2022 · Medical PolicyMedical Policy and Coding Updates - January 2023MediumEffective Apr 9, 2023 · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesGeneticsOncologyPsychiatryNeurologyCardiologyGastroenterologyDermatologyRheumatologyOB-GYNPlastic SurgeryPharmacyUrologyOrthopedicsCode A2014Code A2015Code A2016Code A2017Code A2018Code A4596Code J9298Code J1551Code C9745Code J0585Code J0586Code J0587Code J0588Code 90870Code 27703

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