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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA · Oncology, Neurology, Rheumatology +5 moreHigh impact

Medical Policy and Coding Updates - March 2020

Act
immediately
Effective date
Jun 5, 2020
Identified
Jun 18, 2026

Summary

Multiple drug and treatment policies updated with new medications, biosimilar preferences, and prior authorization requirements. Key changes include new biosimilar hierarchies for cancer drugs, updated age criteria for asthma medications, and new prior authorization requirements for multiple sclerosis treatments.

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What to do

immediately · 5 steps
01Update billing system to require prior authorization for J2350 (Ocrevus).
02By March 5, 2020: Update prior authorization requirements for codes A6460, A6461, Q4220, Q4222, Q4226 for bio-engineered skin substitutes.
03Update sacral nerve stimulation codes 64585, 64590, 64595 from investigational to medical necessity review.
04Remove prior authorization requirements for dry needling codes 20560, 20561.
05Billing team must verify biosimilar hierarchies when billing for cancer treatments - use first-line biosimilars before second-line options to avoid denials.

Codes mentioned

J2350A6460A6461Q4220Q4222Q4226Q4179Q41826458564590645952056020561

Original notice

Medical Policy and Coding Updates - March 2020
premera.com · Always check the source before changing claims.
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Related changes

See all Premera Blue Cross changes →
Medical Policy and Coding Updates - January 2018HighEffective Jan 1, 2018 · Medical PolicyMedical Policy and Coding Updates - November 2019MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2020MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - July 2018MediumNo effective date · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOncologyNeurologyRheumatologyPulmonologyEndocrinologyWound CarePain ManagementOrthopedicsCode J2350Code A6460Code A6461Code Q4220Code Q4222Code Q4226Code Q4179Code Q4182Code 64585Code 64590Code 64595Code 20560Code 20561

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