CommercialPrior AuthHigh impact
Medical Policy and Coding Updates - September 2020
Premera Blue Cross·WA, AK · Oncology, Hematology, Rheumatology +4 more·Medical Policy
Effective date
Sep 1, 2020
We identified it
Jun 18, 2026
Summary
Multiple oncology and specialty drugs have been added to covered policies with new prior authorization requirements, effective across three dates in September-December 2020. New billing codes have been added requiring prior auth review, while some amniotic membrane injection codes no longer require authorization.
Action Required
By December 3, 2020: Billing team must update system to require prior authorization for new drug codes J2507, J9305, and J9307. Update encounter forms to reflect that codes 65778 and 65779 (amniotic membrane injections) no longer require prior auth. Configure investigational review alerts for code 0062U. Train staff that tandem autologous hematopoietic cell transplantation for Hodgkin lymphoma is now investigational and will require special handling.