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Medical Policy and Coding Updates - September 2018
Premera Blue Cross·WA · Pain Management, Endocrinology, Oncology +6 more·Medical Policy
Effective date
Sep 1, 2018
We identified it
Jun 18, 2026
Summary
Multiple medical policies are being updated with new coverage determinations and prior authorization requirements. Key changes include new investigational determinations for pain management procedures, updated imaging guidelines, and revised prior authorization requirements for specific codes including testosterone pellets and thyroid testing.
Action Required
By September 1, 2018: Billing team must update systems to require prior authorization for S0189 (testosterone pellet), 0026U (thyroid testing), and 0002U (colorectal screening). Remove prior authorization requirements for codes 31660, 31661 (bronchial thermoplasty), 81455 (genomic sequencing), 81551 (prostate cancer testing), and A7025, A7026 (oscillatory device accessories). Add prior authorization for 81545 (thyroid gene expression) and E0481, E0483 (respiratory oscillatory devices). Update encounter forms and notify providers of investigational status for multiple pain management procedures.