Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Oncology, Nuclear Medicine, Bariatric Surgery +8 moreMedium impact
Medical Policy and Coding Updates - August 2022
Effective date
Nov 4, 2022
Identified
Jun 18, 2026
Summary
Effective November 4, 2022, Cutaquig (immune globulin subcutaneous) is added to site of service review under Immune Globulin Therapy and under Infusion Drugs and Biologic Agents, and an authorization policy for observation versus inpatient admission level of care is added for individual plans. Effective August 1, 2022, codes A9593, A9594, A9595, A9596 and A9699 for therapeutic radiopharmaceuticals newly require medical necessity review and prior authorization, and transoral outlet reduction (TORe) and restorative obesity surgery, endoluminal (ROSE) are considered investigational. Effective August 5, 2022, code J0219 now requires medical necessity review, including site of service, and prior authorization.
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01Already effective August 1, 2022 for the radiopharmaceutical codes and August 5, 2022 for code J0219.
02Billing team: get prior authorization for A9593, A9594, A9595, A9596 and A9699, and for J0219, which also requires site of service review.
03Tell providers that Cutaquig now has site of service review starting November 4, 2022, and that observation versus inpatient admission criteria apply to individual plans.
04Check current applicability of these historical dates before acting.
Codes mentioned
A9593A9594A9595A9596A9699J0219A950717106K1023
Original notice
Medical Policy and Coding Updates - August 2022
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