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Medical Policy and Coding Updates - January 2022
Premera Blue Cross·WA · Orthopedics, Neurosurgery, OB-GYN +6 more·Medical Policy
Effective date
Jan 7, 2022
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated medical policy and coding guidelines effective January-March 2022, including changes to AIM Specialty Health imaging guidelines, new drug policies with site of service reviews, and surgical procedure prior authorization requirements. Key changes include new medical necessity criteria for spinal surgeries and hysterectomies, plus site of service reviews for multiple infusion drugs.
Action Required
Immediately: Update prior authorization workflows for cervical spine surgeries (CPT 22551, 22554, 22600, 63020, 63045) and lumbar spinal fusions (CPT 22553, 22558, 22612, 22630, 22633) to include site of service review. Update encounter forms and billing system to flag hysterectomy procedures (CPT 58260-58294, 58550-58554) for new medical necessity criteria. Remove HCPCS C1726 from billing system. Train staff on new AIM Specialty Health imaging guidelines effective March 13, 2022.