Premera Blue CrossAll Plans · Prior Auth · Medical Policy · WA, AK · Orthopedics, Podiatry, Oncology +6 moreMedium impact
Medical Policy and Coding Updates - August 2019
Effective date
Not stated in the notice
Identified
Jun 18, 2026
Summary
Effective August 1, 2019, handheld radiofrequency spectroscopy code 0546T now requires review for investigational status, and functional electrical stimulation code E0770 now requires review for investigational status and no longer requires prior authorization. Effective August 2, 2019, denosumab code J0897 now requires review for medical necessity and prior authorization, and synthetic cartilage implant codes 28291, L8641 and L8642 now require review for investigational status and prior authorization. Transcatheter mitral valve repair codes 0483T and 0484T no longer require review for medical necessity or prior authorization, and genetic testing codes G0452 and S3620 are no longer reviewed for medical necessity.
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01Already effective August 1, 2019: Check current applicability before billing 0546T, E0770, 0080U and 0092U, which this update listed as requiring review for investigational status.
02Already effective August 2, 2019: Check current applicability before billing J0897, 28291, L8641 and L8642, which this update listed as requiring prior authorization.
03Code Q5115 was listed as requiring review of site of service as well as medical necessity and as currently requiring prior authorization.
04Codes 0483T and 0484T were listed as no longer requiring prior authorization, and G0452 and S3620 were listed as no longer reviewed for medical necessity.
Codes mentioned
E0770J089728291L8641L8642Q5115G0452S3620
Original notice
Medical Policy and Coding Updates - August 2019
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