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Medical Policy and Coding Updates - December 2019
Premera Blue Cross·WA · Orthopedics, Oncology, Neurology +6 more·Medical Policy
Effective date
Jan 1, 2020
We identified it
Jun 18, 2026
Summary
Multiple policy updates effective at various dates from January 2020 through March 2020, including new requirements for knee arthroplasty (adding Kellgren-Lawrence grade 3 criteria and requiring both medical and physical conservative management), site of service reviews for Ocrevus infusions, genetic testing restrictions, and various coverage changes for procedures like cryosurgical ablation and cardiac devices.
Action Required
By March 5, 2020: Update knee arthroplasty documentation to include Kellgren-Lawrence grade 3 radiographic evidence and ensure both medical and physical conservative management are documented before surgery. By March 4, 2020: Implement site of service review requirements for Ocrevus (ocrelizumab) IV infusions. By February 21, 2020: Begin using InterQual criteria for physical therapy and occupational therapy service reviews for individual plans. Update billing systems and clinical documentation templates to reflect all new medical necessity criteria across affected specialties.