Coding and coverage updates for selected services and drugs
Lists code-level coverage determinations, prior authorization requirements, and effective dates across MGB ACO, Commercial/ASO, and Medicare Advantage lines; indicates which codes are covered, not covered, or require authorization.
CPT code 61889 is covered with prior authorization required for MGB ACO and Commercial/ASO Plans effective 1/1/2024.
CPT codes 61891 and 61892 are covered with no prior authorization required for MGB ACO and Commercial/ASO Plans effective 1/1/2024.
Multiple influenza vaccine codes (90653, 90656, 90657, 90658, 90660, 90661, 90673) are covered for preventive flu shots for Medicare Advantage Plans effective 10/1/2024.
Several injectable drugs (e.g., atezolizumab + hyaluronidase subcutaneous, tislelizumab J9329, guselkumab J1628, faricimab J2777) are covered under the medical benefit with prior authorization for Commercial/ASO Plans effective 11/01/2024.
Bortezomib (Boruzu) is covered under the medical benefit without prior authorization for Medicare Advantage Plans effective 11/01/2024.
Code E0761 is not covered for MGB ACO Plans; use or billing may be denied.
Codes S0280 and S0281 are not covered for Commercial/ASO Plans; use or billing may be denied.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.