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Medical Policy and Coding Updates - July 2020
Effective date
Not stated in the notice
Identified
Jun 18, 2026
Summary
Effective July 1, 2020, Autologous Chondrocyte Implantation policy 7.01.48 and Electrical Stimulation of the Spine policy 7.01.85 replaced policies 7.01.569 and 7.01.571, and SARS-CoV-2 serology criteria were updated to align with CDC interim guidelines issued May 23, 2020. Effective October 2, 2020, Pharmacologic Treatment of Infertility was added as a new policy covering brand chorionic gonadotropin, Bravelle, Follistim AQ and Pregnyl, and Kyprolis and Velcade were added under Miscellaneous Oncology Drugs. Coding updates made numerous codes subject to medical necessity and prior authorization review, including HCPCS J0791, J0223, E0761, J0896, Q5120, J9358, J1558, J9177, J1429, J3399, Q5119 and Q5121, and removed that review for many codes, including CPT 33981, 33982 and 33983 and the InterQual-reviewed wheelchair and hospital bed codes.
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What to do
Action · 4 steps
01Already effective July 1, 2020: HCPCS J0791, J0223, E0761, J0896, Q5120, J9358, J1558, J9177, J1429, Q5121, J3399 and Q5119 now require medical necessity and prior authorization review, and CPT 43266 now requires medical necessity review.
02CPT 0172U, 0173U, 0175U, 0177U and 0179U are reviewed for medical necessity and require prior authorization.
03Already effective July 2, 2020: CPT 0600T and 0601T now require investigative review, and CPT 33990, 33991, 33992 and 33993 no longer require investigative review.
04CPT 33981, 33982 and 33983 no longer require medical necessity and prior authorization review, and the listed InterQual-reviewed wheelchair, hospital bed and patient lift codes no longer require medical necessity and prior authorization review.
Codes mentioned
E0769G0281G0282G0295G032943266J0791J0223E0761J0896Q5120J9358J1558J9177J1429Q5121J3399Q5119S211293701934609346119105618682728064625E0265E0266E0296E0297E0300E0912S2120E0481E0642E0675E1230K0899G0460S90554151241530S2080216854295033981339823398333990339913399233993E0950E0955E1012E1014E1031E1037E1038E1039E1050E1060E1070E1083E1084E1085E1086E1087E1088E1089E1090E1092E1093E1100E1110E1130E1140E1150E1160E1170E1171E1172E1180E1190E1195E1200E1220E1221E1222E1223E1224E1225E1226E1229E1240E1250E1260E1270E1285E1290E1295E2227E2228E2230E2291E2292E2293E2294E2295E2300E2310E2311E2331E2341E2342E2343E2351E2398E2603E2604E2605E2606E2607E2608E2610E2613E2614E2615E2616E2620E2621E2622E2623E2624E2625K0003K0004K0009K0010K0011K0012K0014K0830K0831K0898K0900
Original notice
Medical Policy and Coding Updates - July 2020
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Related changes
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Related policy hubs
Premera Blue Cross policiesWA policy changesOncologyHematologyPharmacyRheumatologyGastroenterologyNeurologyPulmonologyOrthopedicsOB-GYNPathologyCode E0769Code G0281Code G0282Code G0295Code G0329Code 43266Code J0791Code J0223Code E0761Code J0896Code Q5120Code J9358Code J1558Code J9177Code J1429Code Q5121Code J3399Code Q5119Code S2112Code 93701Code 93460Code 93461Code 19105Code 61868Code 27280Code 64625Code E0265Code E0266Code E0296Code E0297Code E0300Code E0912Code S2120Code E0481Code E0642Code E0675Code E1230Code K0899Code G0460Code S9055Code 41512Code 41530Code S2080Code 21685Code 42950Code 33981Code 33982Code 33983Code 33990Code 33991Code 33992Code 33993Code E0950Code E0955Code E1012Code E1014Code E1031Code E1037Code E1038Code E1039Code E1050Code E1060Code E1070Code E1083Code E1084Code E1085Code E1086Code E1087Code E1088Code E1089Code E1090Code E1092Code E1093Code E1100Code E1110Code E1130Code E1140Code E1150Code E1160Code E1170Code E1171Code E1172Code E1180Code E1190Code E1195Code E1200Code E1220Code E1221Code E1222Code E1223Code E1224Code E1225Code E1226Code E1229Code E1240Code E1250Code E1260Code E1270Code E1285Code E1290Code E1295Code E2227Code E2228Code E2230Code E2291Code E2292Code E2293Code E2294Code E2295Code E2300Code E2310Code E2311Code E2331Code E2341Code E2342Code E2343Code E2351Code E2398Code E2603Code E2604Code E2605Code E2606Code E2607Code E2608Code E2610Code E2613Code E2614Code E2615Code E2616Code E2620Code E2621Code E2622Code E2623Code E2624Code E2625Code K0003Code K0004Code K0009Code K0010Code K0011Code K0012Code K0014Code K0830Code K0831Code K0898Code K0900