All PlansCoverageHigh impact
Medical Policy and Coding Updates - August 2022
Premera Blue Cross·WA · Orthopedics, Neurosurgery, OB-GYN +7 more·Medical Policy
Effective date
Aug 5, 2022
We identified it
Jun 18, 2026
Summary
This comprehensive policy update includes multiple effective dates from August through November 2022, covering changes to imaging guidelines, sleep disorder management, genetic testing, surgical procedures, drug coverage, and various medical necessity criteria. Key changes include updated conservative management timeframes, new medical necessity requirements for various treatments, and revised imaging guidelines.
Action Required
By November 4, 2022: Billing team must update prior authorization requirements for Cutaquig® immune globulin therapy to include site of service documentation. By September 11, 2022: Update imaging guidelines for AIM Specialty Health approvals - extend rotator cuff conservative management documentation from 4 to 6 weeks, add new screening criteria for carotid imaging, and update sleep study criteria for hypoglossal nerve stimulator follow-up. By September 2, 2022: Update cervical spine fusion criteria to require documentation of hardware failure and 12-month post-fusion imaging for pseudoarthritis cases, modify hysterectomy documentation for fibroid cases, and ensure Spravato patients have substance use screening documented. Failure to meet updated medical necessity criteria will result in claim denials.