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Medical Policy and Coding Updates - May 2021
Premera Blue Cross·WA · Oncology, Endocrinology, Cardiology +5 more·Medical Policy
Effective date
May 1, 2021
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective at different dates from May to August 2021, including new drug coverage, updated medical necessity criteria for various treatments, revised bariatric surgery requirements, and molecular testing guidelines. Key changes include reduced pre-surgical weight loss program requirements (6 months to 3 months) and numerous new drug additions across multiple therapeutic areas.
Action Required
By May 1, 2021: Billing team must update prior authorization requirements for code 0507T (eyelid thermal pulsation) as it now requires investigational review. Update bariatric surgery documentation requirements to reflect reduced timeframe (3 continuous months within 12-month period vs previous 6 months within 2 years). Review and update formulary coverage for all newly added drugs across oncology, neurology, cardiology, and other specialty areas. Update molecular testing criteria for solid tumors and hematologic malignancies per AIM Specialty Health guidelines effective May 10, 2021.