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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Orthopedics, Neurosurgery, OB-GYN +21 moreMedium impact

Medical Policy and Coding Updates - January 2022

Effective date
Mar 13, 2022
Identified
Jun 18, 2026

Summary

Advanced imaging guideline changes apply for dates of service on and after March 13, 2022. Ultrasound is now required before advanced imaging for jaundice in pediatric patients and before MRI for uterine leiomyomata (fibroids), and for acoustic neuroma the CT brain indication was removed and replaced with CT temporal bone. Effective January 7, 2022, single-level cervical and lumbar spine procedures and some hysterectomy procedures require site of service review for medical necessity, and hysterectomy for non-malignant conditions requires medical necessity review and prior authorization. Effective January 1, 2022, many drug and procedure codes newly require medical necessity review and prior authorization, and several other codes require review for investigational status.

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What to do

Action · 4 steps
01Already effective March 13, 2022 for the advanced imaging changes and January 7, 2022 for the site of service changes.
02Billing team: get prior authorization for the codes that now require review for medical necessity and prior authorization, such as 58150, 58152 and 58180 for hysterectomy.
03For codes that now require site of service review, such as CPT 22551, 22554, 22600, 63020 and 63045, check the site of service requirements before billing.
04Check current applicability of these historical dates before acting.

Codes mentioned

H0031H0032H2014H2019S5108S5109S5110S51115815058152581805854158542585435854458570585715857258573582605826258263582675827058275582805829058291582925829458550585525855358554A2001Q4199J0172A2002A2003A2004A2005A2006A2007A2008A2009A2010J3031Q205530117C9771C9085J90611196015788157891579215793210872121040500405104052040525405275343054520157751577617380544005440154405C1813C2622J1952J927269716697196305263053J9021K10273326733268332696173661737646286462943497C908664582645836458433370C1884J250681349815232255122554226006302063045225332255322558226122263022633C1726C9081C9083C90826971569718C9752C9753J2505T2036T2037

Original notice

Medical Policy and Coding Updates - January 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 - November 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2025HighEffective Jan 2, 2026 · Medical PolicyMedical Policy and Coding Updates - December 2025HighNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesOrthopedicsNeurosurgeryOB-GYNRadiologyOncologyCardiologyCardiothoracic SurgeryAllergy & ImmunologyDermatologyOphthalmologyRheumatologyGastroenterologyNeurologyPulmonologyHematologyPsychiatryPain ManagementSleep MedicinePediatricsENT (Ear, Nose & Throat)GeneticsPharmacyGeneral SurgeryInternal MedicineCode H0031Code H0032Code H2014Code H2019Code S5108Code S5109Code S5110Code S5111Code 58150Code 58152Code 58180Code 58541Code 58542Code 58543Code 58544Code 58570Code 58571Code 58572Code 58573Code 58260Code 58262Code 58263Code 58267Code 58270Code 58275Code 58280Code 58290Code 58291Code 58292Code 58294Code 58550Code 58552Code 58553Code 58554Code A2001Code Q4199Code J0172Code A2002Code A2003Code A2004Code A2005Code A2006Code A2007Code A2008Code A2009Code A2010Code J3031Code Q2055Code 30117Code C9771Code C9085Code J9061Code 11960Code 15788Code 15789Code 15792Code 15793Code 21087Code 21210Code 40500Code 40510Code 40520Code 40525Code 40527Code 53430Code 54520Code 15775Code 15776Code 17380Code 54400Code 54401Code 54405Code C1813Code C2622Code J1952Code J9272Code 69716Code 69719Code 63052Code 63053Code J9021Code K1027Code 33267Code 33268Code 33269Code 61736Code 61737Code 64628Code 64629Code 43497Code C9086Code 64582Code 64583Code 64584Code 33370Code C1884Code J2506Code 81349Code 81523Code 22551Code 22554Code 22600Code 63020Code 63045Code 22533Code 22553Code 22558Code 22612Code 22630Code 22633Code C1726Code C9081Code C9083Code C9082Code 69715Code 69718Code C9752Code C9753Code J2505Code T2036Code T2037

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