CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - October 2020
Premera Blue Cross·WA · Oncology, Hematology, Rheumatology +5 more·Medical Policy
Effective date
Oct 1, 2020
We identified it
Jun 18, 2026
Summary
Premera Blue Cross updated multiple medical policies with new drug coverage, prior authorization requirements, and billing codes effective October 1, 2020 through January 1, 2021. Key changes include new oncology drugs, autoimmune disease treatments, infertility medications, and updated prior authorization requirements for various specialty medications and procedures.
Action Required
Immediately (policies already in effect): Billing team must update system to require prior authorization for codes J9041, J9047, J0725, J3355, A9606, J9043, J3032, J9227, J1632, and multiple molecular testing codes (0015M, 0203U-0218U). Remove T2047 from covered services. Update encounter forms to flag these codes for prior auth requirements. Notify providers that claims will be denied without proper authorization.