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Medical Policy and Coding Updates - February 2021
Premera Blue Cross·WA, AK · Oncology, Hematology, Radiology +6 more·Medical Policy
Effective date
May 10, 2021
We identified it
Jun 18, 2026
Summary
This comprehensive policy update affects molecular testing criteria for oncology, imaging guidelines, new drug coverages, and medical device criteria across multiple specialties. Key changes include expanded molecular testing for various cancers, revised imaging requirements for brain/cardiac conditions, new VEGF inhibitor coverage for eye conditions, and lowered age requirements for artificial pancreas devices and cochlear implants.
Action Required
By May 10, 2021: Update prior authorization and billing systems to reflect new molecular testing criteria for oncology patients, including new requirements for SelectMDx (81479), PCA3 (81313), ExomeDx (0005U), and ConfirmMDx (81551). Review and update imaging authorization protocols for brain, cardiac, and radiation oncology services. Update drug formulary systems for new VEGF inhibitors and verify coverage criteria. Notify providers of revised documentation requirements for molecular testing and imaging services.