← Back to list
Medical Policy and Coding Updates - October 2022
Effective date
Dec 1, 2022
Identified
Jun 18, 2026
Summary
Effective December 1, 2022, botulinum toxin codes J0585, J0586, J0587 and J0588 require medical necessity review and prior authorization. Effective October 1, 2022, AIM Specialty Health genetic testing codes such as 0332U through 0350U are reviewed by AIM Specialty Health and require prior authorization, and codes Q2056, J1302, J9274, Q5125 and J2777 now require medical necessity review and prior authorization. Effective January 6, 2023, electroconvulsive therapy (ECT) and total ankle replacement are reviewed under InterQual criteria, and code 90870 now requires medical necessity review and prior authorization.
Get alerts when payers change rules like this one
We check Premera Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Premera Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
Action · 6 steps
01Already effective October 1, 2022 for the coding changes and December 1, 2022 for botulinum toxin codes.
02Billing team: get prior authorization for Q2056, J1302, J9274, Q5125, J2777, J0585, J0586, J0587 and J0588, and for the AIM Specialty Health genetic testing codes, which AIM Specialty Health now reviews and requires prior authorization for.
03Codes A9607, A9800 and C1062 now require medical necessity review.
04Codes 0337U, 0338U, 0342U and 0344U now require review for investigational status.
05For dates of service starting January 6, 2023, code 90870 requires medical necessity review and prior authorization.
06Check current applicability of these historical dates before acting.
Codes mentioned
Q2056J1302J9274T1032T1033C1062A9607A9800Q5125J27773166031661C9094S2140C9095C1823C9096C9097J0585J0586J0587J05889087027703
Original notice
Medical Policy and Coding Updates - October 2022
premera.com · Always check the source before changing claims.
Related changes
See all Premera Blue Cross changes →Medical Policy and Coding Updates - December 2022MediumEffective Apr 9, 2023 · Medical PolicyMedical Policy and Coding Updates - November 2022MediumEffective Feb 18, 2023 · Medical PolicyMedical Policy and Coding Updates - July 2022MediumEffective Sep 11, 2022 · Medical PolicyMedical Policy and Coding Updates - September 2022MediumEffective Dec 1, 2022 · Medical PolicyBrowse every Premera Blue Cross change in the policy list
Related policy hubs
Premera Blue Cross policiesWA policy changesAK policy changesOncologyHematologyPulmonologyCardiologyOB-GYNEndocrinologyPain ManagementPsychiatryGeneticsPharmacyNeurologyOphthalmologyUrologyDermatologyGastroenterologyOrthopedicsGeneral SurgeryCode Q2056Code J1302Code J9274Code T1032Code T1033Code C1062Code A9607Code A9800Code Q5125Code J2777Code 31660Code 31661Code C9094Code S2140Code C9095Code C1823Code C9096Code C9097Code J0585Code J0586Code J0587Code J0588Code 90870Code 27703