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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Oncology, Rheumatology, Dermatology +4 moreHigh impact

Medical Policy and Coding Updates - April 2022

Act
immediately
Effective date
Apr 1, 2022
Identified
Jun 18, 2026

Summary

Premera Blue Cross updated multiple policies effective April 1, 2022, with additional changes through July 7, 2022. Key changes include new prior authorization requirements for various drugs and procedures, coverage changes for cancer treatments, and updates to autoimmune disease therapies including new atopic dermatitis treatments.

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What to do

immediately · 5 steps
01Update billing system to require prior authorization for codes J9273, J9359, J0219, J0879, J0491, C9093, Q5124, and genetic testing codes 0306U-0320U.
02Mark codes H2038, T2050, T2051 as non-covered.
03Update investigational review requirements for amniotic membrane codes Q4224, Q4225, Q4256, Q4257, Q4258 and bioengineered skin substitute codes A2011, A2012, A2013.
04Remove terminated codes C9084, C9085, C9086 from system.
05Notify providers of new atopic dermatitis drug coverage and reduced trial requirements for Dupixent.

Codes mentioned

Q4224Q4225Q4256Q4257Q4258J9273J9359A2011A2012A2013C9090J0219J0879C9091H2038T2050T2051K1028K1029J0491A9291C9093Q5124E0761C9084C9085C9086Q5109

Original notice

Medical Policy and Coding Updates - April 2022
premera.com · Always check the source before changing claims.
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Related changes

See all Premera Blue Cross changes →
Medical Policy and Coding Updates - July 2022MediumEffective Sep 11, 2022 · Medical PolicyMedical Policy and Coding Updates - January 2022MediumEffective Mar 13, 2022 · Medical PolicyMedical Policy and Coding Updates - April 2018MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2019MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOncologyRheumatologyDermatologyAllergy & ImmunologyWound CareOphthalmologyNeurologyCode Q4224Code Q4225Code Q4256Code Q4257Code Q4258Code J9273Code J9359Code A2011Code A2012Code A2013Code C9090Code J0219Code J0879Code C9091Code H2038Code T2050Code T2051Code K1028Code K1029Code J0491Code A9291Code C9093Code Q5124Code E0761Code C9084Code C9085Code C9086Code Q5109

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