All PlansCoverageHigh impact
Medical Policy and Coding Updates - January 2021
Premera Blue Cross·WA · Oncology, Radiology, Diagnostic Imaging +6 more·Medical Policy
Effective date
Jan 1, 2021
We identified it
Jun 18, 2026
Summary
This comprehensive policy update includes multiple changes across medical, pharmacy, and imaging policies with staggered effective dates from January to April 2021. Key changes include new drug approvals (Jelmyto for oncology, Xembify for immune therapy), updated AIM Specialty Health imaging guidelines, revised medical necessity criteria for various procedures, and age requirement changes for certain devices and treatments.
Action Required
By April 7, 2021: Billing teams must update systems with new drug codes for Jelmyto and Xembify, implement revised AIM Specialty Health imaging authorization requirements effective March 14, 2021, update medical necessity criteria for artificial pancreas systems (age 6+), cochlear implants (9+ months), and knee arthroscopy restrictions for degenerative tears without functional impairment. Review and implement all reinstated policies effective February 5, 2021. Update prior authorization workflows for imaging studies per new AIM guidelines to prevent claim denials.