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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Oncology, Hematology, Orthopedics +12 moreMedium impact

Medical Policy and Coding Updates - August 2021

Effective date
Not stated in the notice
Identified
Jun 18, 2026

Summary

This Premera medical policy and coding update lists changes from August 2021. Effective August 1, 2021, a prescription digital therapeutics policy was added, with some FDA-approved products considered investigational, and continuous glucose monitoring supplies gained quantity limits. Coding changes effective August 1 and August 6, 2021 added medical necessity or prior authorization review to codes including J2353, J2354, J1930 and T1505, and a site of service review was added for J1429. The update also lists an allograft injection for degenerative disc disease as investigational, effective November 5, 2021.

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What to do

Action · 6 steps
01Already effective August 6, 2021: Pharmacotherapy of Cushing's disease and acromegaly codes J2353, J2354 and J1930 now require review for medical necessity and prior authorization.
02Already effective August 6, 2021: infusion drug code J1429 now requires review for site of service.
03Already effective August 1, 2021: prescription digital therapeutic code T1505 now requires review for medical necessity, and digital breast tomosynthesis codes 77065, 77066 and 77067 now require review for medical necessity.
04Already effective August 1, 2021: codes 21685 and 42950 now require review for medical necessity, and codes 41512, 41530 and S2080 now require review for investigative care.
05Already effective November 5, 2021: allograft injection for degenerative disc disease codes 0627T, 0628T, 0629T and 0630T now require review for investigative care.
06Check current applicability rather than acting on these past dates.

Codes mentioned

J2353J2354J1930S934764451T150521685429504151241530S2080J142936516971519715397154971559715697158H0015H0017H0035S948027269L0622L0623L0624J0256A62051100877065770667706790377

Original notice

Medical Policy and Coding Updates - August 2021
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 - June 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - July 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - September 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - July 2020MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOncologyHematologyOrthopedicsRadiologySleep MedicineENT (Ear, Nose & Throat)PharmacyNeurologyPsychiatryEndocrinologyCardiologyGastroenterologyNephrologyInfectious DiseaseWound CareCode J2353Code J2354Code J1930Code S9347Code 64451Code T1505Code 21685Code 42950Code 41512Code 41530Code S2080Code J1429Code 36516Code 97151Code 97153Code 97154Code 97155Code 97156Code 97158Code H0015Code H0017Code H0035Code S9480Code 27269Code L0622Code L0623Code L0624Code J0256Code A6205Code 11008Code 77065Code 77066Code 77067Code 90377

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