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Premera Blue CrossCommercial · Prior Auth · Medical Policy · WA, AK · Orthopedics, Cardiology, Ophthalmology +8 moreMedium impact

Medical Policy and Coding Updates - September 2019

Effective date
Not stated in the notice
Identified
Jun 18, 2026

Summary

Effective January 1, 2020, for individual plans only, subcutaneous implantable cardiac defibrillator code 33270, total ankle replacement codes 27702 and 27703, negative pressure wound therapy codes A6550, A7000 and E2402, and spinal orthosis codes such as L0450 and L0460 now require review for medical necessity and prior authorization, along with nerve block codes such as 64450 and 64490 and trigger point injection codes 20552 and 20553. Effective January 1, 2020, for individual plans only, many other codes including 92132, 77046 through 77049, 90460, 90461 and E0424 now require review for medical necessity. Effective September 1, 2019, hyoid myotomy code 21685 and denosumab code J0897 now require review for medical necessity and prior authorization, while lumbar discectomy codes 62287 and 62380 are reviewed for investigational status and no longer require prior authorization.

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What to do

Action · 3 steps
01Already effective September 1, 2019: Check current applicability before billing 21685 and J0897, which this update listed as requiring review for medical necessity and prior authorization, and 62287 and 62380, which it listed as no longer requiring prior authorization.
02Already effective January 1, 2020: For individual plans only, check current applicability before billing 33270, 27702, 27703, A6550, A7000, E2402, 20552, 20553 and the spinal orthosis codes, which this update listed as requiring review for medical necessity and prior authorization.
03For individual plans only, the other codes in this update, such as 92132, 77046 through 77049 and 95930, were listed as requiring review for medical necessity.

Codes mentioned

332702770227703A6550A7000E2402L0450L0460L0621L4002L09806445064455644906449164492644936449464495205522055364479644806448364884205262709677003G0260911109111191200921329091190901A4606E044577061770627706377046770477704877049770657706677067G027958353583565856334701348123482034841G016666174661756618390460904619047190472466014660794774947759477694777E0424E0431E1390K0738G0248G0249G025090649906509065131513315703157131573315749062190644907339073464566669826698366984V2630V2631V263258720589409067590676907369075093668A4450A4452A6010A6011A6545E0691E0692A46339593021685J08976228762380

Original notice

Medical Policy and Coding Updates - September 2019
premera.com · Always check the source before changing claims.
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Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesOrthopedicsCardiologyOphthalmologyPediatricsGeneral PracticeOB-GYNPain ManagementGastroenterologyPulmonologyGeriatricsWound CareCode 33270Code 27702Code 27703Code A6550Code A7000Code E2402Code L0450Code L0460Code L0621Code L4002Code L0980Code 64450Code 64455Code 64490Code 64491Code 64492Code 64493Code 64494Code 64495Code 20552Code 20553Code 64479Code 64480Code 64483Code 64884Code 20526Code 27096Code 77003Code G0260Code 91110Code 91111Code 91200Code 92132Code 90911Code 90901Code A4606Code E0445Code 77061Code 77062Code 77063Code 77046Code 77047Code 77048Code 77049Code 77065Code 77066Code 77067Code G0279Code 58353Code 58356Code 58563Code 34701Code 34812Code 34820Code 34841Code G0166Code 66174Code 66175Code 66183Code 90460Code 90461Code 90471Code 90472Code 46601Code 46607Code 94774Code 94775Code 94776Code 94777Code E0424Code E0431Code E1390Code K0738Code G0248Code G0249Code G0250Code 90649Code 90650Code 90651Code 31513Code 31570Code 31571Code 31573Code 31574Code 90621Code 90644Code 90733Code 90734Code 64566Code 66982Code 66983Code 66984Code V2630Code V2631Code V2632Code 58720Code 58940Code 90675Code 90676Code 90736Code 90750Code 93668Code A4450Code A4452Code A6010Code A6011Code A6545Code E0691Code E0692Code A4633Code 95930Code 21685Code J0897Code 62287Code 62380

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