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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Dermatology, Neurology, Urology +13 moreMedium impact

Medical Policy and Coding Updates - September 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 for dates of service starting on that date, and the new Botulinum Toxins policy (5.01.512) covers the listed indications. Krystexxa (pegloticase) must be given with oral methotrexate 15 mg weekly, unless there is a medical reason why methotrexate can't be taken. Effective September 1, 2022, codes J0591, 17107 and 17108 require review for cosmetic and prior authorization, and Dupixent (dupilumab) age criteria for atopic dermatitis changed from 6 years to 6 months of age and older.

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What to do

Action · 5 steps
01Already effective September 1, 2022 for the Dupixent, cosmetic and removed code changes, and December 1, 2022 for botulinum toxin codes.
02Billing team: get prior authorization for J0585, J0586, J0587 and J0588, which now require medical necessity review and prior authorization for dates of service starting December 1, 2022.
03Individuals from 6 months to 2 years of age must try one topical prescription corticosteroid of any potency before Dupixent can be prescribed.
04Cosmetic codes J0591, 17107 and 17108 require review for cosmetic and prior authorization.
05Check current applicability of these historical dates before acting.

Codes mentioned

J0585J0586J0587J0588J05911710717108K1023J142743266

Original notice

Medical Policy and Coding Updates - September 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 - November 2022MediumEffective Feb 18, 2023 · Medical PolicyMedical Policy and Coding Updates - December 2022MediumEffective Apr 9, 2023 · Medical PolicyMedical Policy and Coding Updates - January 2020MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesDermatologyNeurologyUrologyGastroenterologyRheumatologyOB-GYNPediatricsOphthalmologyPain ManagementPM&R (Physical Medicine & Rehab)Oral & Maxillofacial SurgeryPlastic SurgeryPharmacyOrthopedicsGeneral SurgeryEndocrinologyCode J0585Code J0586Code J0587Code J0588Code J0591Code 17107Code 17108Code K1023Code J1427Code 43266

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