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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Oncology, Pathology, Radiology +5 moreMedium impact

Medical Policy and Coding Updates - February 2021

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

Summary

This Premera medical policy and coding update lists changes from February 2021. Updated AIM Specialty Health molecular testing criteria took effect May 10, 2021, adding tumor markers such as FoundationOne CDx and revising MRD testing so it must be performed on bone marrow. Other changes include revised advanced imaging criteria effective March 14, 2021, and medical necessity or prior authorization review added or removed for several codes effective February 1 and February 5, 2021.

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What to do

Action · 5 steps
01Already effective May 10, 2021: check current applicability of the molecular testing criteria before billing these tests.
02Already effective March 14, 2021: check current applicability of the AIM advanced imaging criteria before billing advanced imaging.
03Already effective February 5, 2021: coronary angiography (93460, 93461) and deep brain stimulation (61868) now require review for medical necessity and prior authorization, and knee orthosis codes such as L1907 and L2128 no longer require review for medical necessity and prior authorization.
04Already effective February 1, 2021: allergy testing (90506) no longer requires review for medical necessity.
05Check current applicability rather than acting on these past dates.

Codes mentioned

814798131381551934609346161868E0265E0266E0296E0297E0300E0912E0481E0642E0985E1230K0899C1767C1778C1787C1820C1822C1883C1897636616366263664636883648236483375003770037718377223773537760377613776537766377803778536473364749329293745E1012E1014E1050E1060E1070E1083E1084E1085E1086E1087E1088E1089E1090E1100E1160E1170E1171E1172E1180E1190E1195E1200E1220E1221E1223E1224E1229E1240E1250E1260E1270E1285E1290E1295E2227E2228E2230E2292E2295E2300E2310E2311E2331E2341E2342E2343E2351E2398E2610E2620E2621E2622E2623K0004K0009K0010K0011K0012K0014K0830K0831K0898K090064625G0259G026027280S0128L1907L1940L1950L1960L1970L1980L1990L2000L2005L2010L2020L2030L2034L2036L2037L2038L2106L2108L2126L21282055590506

Original notice

Medical Policy and Coding Updates - February 2021
premera.com · Always check the source before changing claims.
View original ↗

Related changes

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Medical Policy and Coding Updates - July 2020MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - September 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - June 2018MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - August 2020MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

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