All PlansCoverageMedium impact
Medical Policy and Coding Updates - July 2022
Premera Blue Cross·WA · Orthopedics, Neurosurgery, Cardiology +7 more·Medical Policy
Effective date
Sep 11, 2022
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple clinical appropriateness guidelines effective September 2022, including changes to advanced imaging requirements, genetic testing criteria, surgical procedures, and medication management. Key changes include extended conservative management times, new imaging indications, updated genetic testing criteria, and revised documentation requirements for various specialties.
Action Required
By September 11, 2022: Billing and clinical teams must update authorization workflows to reflect new AIM Specialty Health guidelines. Update conservative management documentation to show 6 weeks (instead of 4) for rotator cuff tears before advanced imaging. Ensure genetic testing requests include updated medical necessity criteria. Review sleep disorder studies to include new occupational safety indications for MWT. Update cervical spine surgery documentation to include hardware failure evidence and 12-month imaging requirements for pseudoarthritis cases.