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Medical Policy and Coding Updates - September 2021
Premera Blue Cross·WA · Oncology, Rheumatology, Orthopedics +5 more·Medical Policy
Effective date
Sep 3, 2021
We identified it
Jun 18, 2026
Summary
This comprehensive policy update adds multiple new drug coverages across oncology, autoimmune diseases, and rare conditions, designates certain procedures as investigational (non-covered), and updates imaging guidelines with stricter prior authorization requirements effective at various dates from September to December 2021.
Action Required
By December 2, 2021: Billing team must update prior authorization systems for all AIM Specialty Health imaging guidelines including spine, extremity, and vascular imaging effective September 12, 2021. Update drug formularies to include newly covered medications like Arcalyst, Abraxane, and Alpha1-proteinase inhibitors. Flag allograft injection for degenerative disc disease and synthetic nerve conduits as investigational/non-covered. Train staff on new conservative management requirements before advanced imaging approval.