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Medical Policy and Coding Updates - November 2021

Premera Blue Cross·WA · Orthopedics, Neurosurgery, OB-GYN +4 more·Medical Policy
Effective date
Feb 4, 2022
We identified it
Jun 18, 2026
Days to comply

Summary

Premera Blue Cross updated multiple medical policies with new coverage criteria, site of service reviews, and billing code changes effective in staggered dates from November 2021 through February 2022. Key changes include new intravitreal corticosteroid coverage, updated medical necessity criteria for various drugs, and site of service requirements for specific surgical procedures including spine and hysterectomy surgeries.

Action Required

Action needed
By February 4, 2022: Billing teams must update systems to require site of service review for single-level cervical and lumbar spinal procedures (CPT codes 22533, 22551, 22554, 22558, 22600, 22612, 22630, 22633, 63020, 63045) and hysterectomy procedures (CPT codes 58260, 58262, 58263, 58267, 58270, 58275, 58280, 58290, 58291, 58292, 58294, 58550, 58552, 58553, 58554). Remove HCPCS code C1726 from billing system. Update prior authorization requirements for new intravitreal corticosteroid drugs and verify medical necessity criteria for IL-5 inhibitors and other specialty medications. Verify patient eligibility and site of service appropriateness before scheduling to prevent claim denials.

Affected Billing Codes

22533
22551
22554
22558
22600
22612
22630
22633
58260
58262
58263
58267
58270
58275
58280
58290
58291
58292
58294
58550
58552
58553
58554
63020
63045
C1726