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Premera Blue CrossAll Plans · Prior Auth · Medical Policy · WA, AK · Orthopedics, Neurosurgery, Pain Management +7 moreMedium impact

Medical Policy and Coding Updates - February 2019

Effective date
Feb 1, 2019
Identified
Jun 18, 2026

Summary

Effective February 1, 2019, cervical spine surgery codes 22600, 63020 and 63045 and sacroiliac joint arthrodesis code 27279 now require review for medical necessity and prior authorization, and sacroiliac joint code 27280 now requires review for medical necessity after being investigational. Hereditary angioedema codes J0596, J0597, J0598, J0599, J1290 and J1744, Trogarzo code J1746 and corneal collagen cross-linking code J2787 also now require prior authorization. Magnetic esophageal sphincter augmentation codes 43284 and 43285 no longer require prior authorization, and patient lift codes E0171 and E0625 are now considered noncovered.

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What to do

Action · 3 steps
01Already effective February 1, 2019: Check current applicability before billing codes 22600, 63020, 63045, 27279, J0596, J0597, J0598, J0599, J1290, J1744, J1746 and J2787, which this update listed as requiring prior authorization.
02Code K0899 (power mobility device) now requires review for prior authorization, code 27280 now requires review for medical necessity, and codes 54200 and 54205 (Peyronie disease injection) were listed as now considered noncovered.
03Codes E0171 and E0625 were listed as now considered noncovered, and codes 43284 and 43285 were listed as no longer requiring prior authorization.

Codes mentioned

2260063020630452727927280J0596J0597J0598J0599J1290J1744J1746J278754200542054328443285E0171E0625K089964568Q4102B4100B4102B4103B4104B4149B4150B4152B4153B4154B4155B4157B4158B4159B4160B4161B4162B9000B9002B9004B9006B9998B9999S9434S9435S9340S9341S9342S9343S9433

Original notice

Medical Policy and Coding Updates - February 2019
premera.com · Always check the source before changing claims.
View original ↗

Related changes

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Medical Policy and Coding Updates - July 2019MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - October 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - November 2021MediumNo effective date · Medical PolicyMedical Policy and Coding Updates - January 2022MediumEffective Mar 13, 2022 · Medical PolicyBrowse every Premera Blue Cross change in the policy list

Related policy hubs

Premera Blue Cross policiesWA policy changesAK policy changesOrthopedicsNeurosurgeryPain ManagementAllergy & ImmunologyInfectious DiseaseOphthalmologyInternal MedicineGastroenterologyGeriatricsGeneral SurgeryCode 22600Code 63020Code 63045Code 27279Code 27280Code J0596Code J0597Code J0598Code J0599Code J1290Code J1744Code J1746Code J2787Code 54200Code 54205Code 43284Code 43285Code E0171Code E0625Code K0899Code 64568Code Q4102Code B4100Code B4102Code B4103Code B4104Code B4149Code B4150Code B4152Code B4153Code B4154Code B4155Code B4157Code B4158Code B4159Code B4160Code B4161Code B4162Code B9000Code B9002Code B9004Code B9006Code B9998Code B9999Code S9434Code S9435Code S9340Code S9341Code S9342Code S9343Code S9433

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