All PlansPrior AuthMedium impact
Medical Policy and Coding Updates - February 2018
Premera Blue Cross·WA · Oncology, Neurology, ENT (Ear, Nose & Throat) +1 more·Medical Policy
Effective date
Feb 1, 2018
We identified it
Jun 18, 2026
Summary
This February 2018 policy update introduces multiple changes including new prior authorization requirements for genetic testing codes, updates to medical necessity criteria for various treatments, and coverage changes for specific procedures. Key impacts include new coding requirements for genetic tests and revised coverage policies for spinal cord stimulation and other treatments.
Action Required
By February 1, 2018: Billing team must update system to require prior authorization for genetic testing codes 81520, 81521, 81230, 81231, 81551, 81258, 81259, 81269, 81448, 81328, 81541 and sinus surgery codes 31253, 31257, 31259, 31298. Mark code 96161 as non-covered service. Update encounter forms to alert providers of new prior auth requirements. Claims without proper authorization will be denied.