All PlansCoverageMedium impact
Medical Policy and Coding Updates - March 2019
Premera Blue Cross·WA · Oncology, Hematology, Rheumatology +4 more·Medical Policy
Effective date
Mar 1, 2019
We identified it
Jun 18, 2026
Summary
Multiple drug coverage criteria updated effective March 2019, including new indications for cancer treatments, arthritis medications, and testosterone therapy requirements. Several nasal/sinus surgery codes now require site of service review, and electronic brachytherapy codes have updated authorization requirements.
Action Required
By March 1, 2019: Update billing system to flag CPT codes 31253, 31257, 31259, and 31298 for site of service review requirements. Remove prior authorization requirements for code 0394T and 0395T for electronic brachytherapy. Pharmacy team must verify updated medical necessity criteria for Lorbrena, Sprycel, Tecentriq, Cabometyx, and Promacta before prescribing.