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Medical Policy and Coding Updates - March 2021
Premera Blue Cross·WA · Oncology, Hematology, Urology +4 more·Medical Policy
Effective date
Mar 1, 2021
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies effective March-May 2021, including expanded molecular testing coverage for various cancers, revised hereditary angioedema treatment criteria, new oncology drug coverage, and updated clinical appropriateness guidelines for advanced imaging and radiation oncology.
Action Required
By May 10, 2021: Billing team must update prior authorization requirements for molecular testing codes including SelectMDx (81479), PCA3 (81313), ExomeDx (0005U), and ConfirmMDx (81551) per revised AIM Specialty Health guidelines. Update encounter forms to reflect new solid tumor markers coverage including FGFR2, MYCN, ALK, and microsatellite instability testing. Verify medical necessity criteria for hereditary angioedema treatments and ensure proper documentation for new oncology drug Jelmyto. Claims not meeting updated criteria will be denied.