All PlansCoverageMedium impact
Medical Policy and Coding Updates - May 2020
Premera Blue Cross·WA, AK · Oncology, Pulmonology, Radiology +6 more·Medical Policy
Effective date
May 1, 2020
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective between May 2020 and August 2020 including new drug coverage criteria, updated radiology guidelines, and revised medical necessity requirements for various treatments. Key changes include new medications being added to formularies, updated imaging criteria for chest and oncology procedures, and revised coverage for surgical treatments.
Action Required
Before August 16, 2020: Update prior authorization processes for chest imaging, breast MRI, and sleep disorder management per new AIM Specialty Health guidelines. By May 1, 2020: Review formulary edits for newly covered medications including Epidiolex, Valtoco, and Juxtapid. Update billing team on new medical necessity criteria for lipectomy/liposuction for lymphedema treatment. Verify coverage criteria for newly added oncology drugs including Padcev and Darzalex.