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Premera Blue CrossAll Plans · Prior Auth · Medical Policy · WA · Ophthalmology, ENT (Ear, Nose & Throat), Neurology +7 moreHigh impact

Medical Policy and Coding Updates - May 2019

Act
by May 1, 2019
Effective date
May 1, 2019
Identified
Jun 18, 2026

Summary

Premera Blue Cross updated multiple medical and pharmacy policies effective May through August 2019, with significant changes including new prior authorization requirements for amniotic membrane procedures, auditory implants, and migraine injections, plus coverage criteria updates for various specialty medications and treatments.

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What to do

by May 1, 2019 · 5 steps
01Billing team must update system to require prior authorization for CPT codes 65778, 65779, 92640, S2235, L8625, and J3030.
02Remove prior authorization requirement for L8695.
03Update Q-codes Q4137, Q4139, Q4148, Q4155, Q4156, Q4162, Q4163 from medical necessity to investigational review and remove prior auth requirements.
04Update Q-codes Q4176, Q4177, Q4178, Q4180, Q4181 to investigational status without prior auth.
05Review all affected specialty medication policies for updated criteria and age restrictions.

Codes mentioned

657786577992640S2235L8625J3030L8695Q4137Q4139Q4148Q4155Q4156Q4162Q4163Q4176Q4177Q4178Q4180Q4181

Original notice

Medical Policy and Coding Updates - May 2019
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 - September 2020HighEffective Sep 1, 2020 · Medical PolicyMedical Policy and Coding Updates - May 2025HighNo effective date · Medical PolicyMedical Policy and Coding Updates - November 2026HighEffective Nov 1, 2026 · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesOphthalmologyENT (Ear, Nose & Throat)NeurologyOncologyRheumatologyGastroenterologyEndocrinologyOrthopedicsWound CarePain ManagementCode 65778Code 65779Code 92640Code S2235Code L8625Code J3030Code L8695Code Q4137Code Q4139Code Q4148Code Q4155Code Q4156Code Q4162Code Q4163Code Q4176Code Q4177Code Q4178Code Q4180Code Q4181

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