Premera Bluecross Prior Authorization Lookup
Latest Premera Bluecross prior authorization updates25
- Prior AuthReimbursement/Payment PolicyEff. 2026-09-01Site of Service Ambulatory Service Center (ASC) SelectDefines medical necessity criteria and prior authorization requirements for the appropriate site of service (ASC, outpatient hospital on/off-campus, inpatient) for certain elective ambulatory surgical and diagnostic procedures for adult patients.All Premera Bluecross updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-09-01Site of Service Ambulatory Service Center (ASC) SelectDefines medical necessity criteria and prior authorization expectations for the site of service (ASC, hospital outpatient, inpatient) for certain elective adult surgical procedures and lists included procedure categories and CPT codes; intended for providers and affects Premera-covered members and their providers.All Premera Bluecross updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-09-01Site of Service Ambulatory Service Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsDefines medical necessity and prior authorization expectations for choice of site of service (ambulatory surgical center, hospital outpatient departments, inpatient) for certain elective surgical and diagnostic procedures and lists included procedure categories and CPT codes where provided. Applies to providers submitting claims to Premera Bluecross.All Premera Bluecross updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-09-01Site of Service Ambulatory Surgical Center (ASC) Select — Site of Service for Ambulatory Surgical Procedures (ASC Select)Guideline for medical necessity review and prior authorization of the site of service for certain elective ambulatory surgical and diagnostic procedures in adults, specifying when procedures should be performed in an Ambulatory Surgical Center versus hospital outpatient or inpatient settings.All Premera Bluecross updates
- Prior AuthReimbursement/Payment PolicyEff. 2026-09-01Site of Service Ambulatory Surgical Center (ASC) Select — Surgical or Diagnostic Procedures in AdultsDefines medical necessity review and preferred site-of-service (including ASC, on-/off-campus outpatient hospital) for certain elective surgical or diagnostic procedures in adults and requirements for prior authorization of site of service.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Antipsychotics — Second‑generation antipsychotic pharmacy coveragePharmacy policy defining medical necessity criteria, prior authorization requirements, age and quantity limits, and documentation expectations for oral second‑generation antipsychotic products managed under the pharmacy benefit.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Bruton Tyrosine Kinase Inhibitors (BTK inhibitors)Pharmacy coverage policy for Bruton Tyrosine Kinase inhibitors intended to guide pharmacy prior-authorization and utilization management, including agent-specific criteria, dose and quantity limits, and initial/re-authorization durations.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01HER2 Inhibitors (Pharmacy / Medical Policy)Clinical and pharmacy coverage criteria, documentation, coding, and authorization guidance for HER2-targeted therapies for oncology indications; intended for providers and prior authorization reviewers.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Immune Globulin Therapy (IVIG/SCIG) Coverage and Site-of-Service CriteriaDefines medical necessity, site-of-service review rules, and clinical coverage criteria for intravenous and injectable immune globulin products; intended for providers requesting prior authorization for immune globulin administration.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pharmacologic Treatment of High CholesterolThis policy governs medical necessity and site-of-service review for pharmacologic treatments used to lower cholesterol (including injectable and IV agents) for Premera members, detailing coverage criteria, dosing limits, and prior authorization/administration site requirements for adults and selected pediatric ages.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pharmacologic Treatment of PsoriasisMedical necessity and site-of-service criteria for systemic, biologic, and infusion/injectable pharmacologic treatments for psoriasis for Premera Bluecross members; intended for providers seeking coverage requirements and prior authorization guidance.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pharmacotherapy of ArthropathiesThis policy governs coverage and prior authorization-related content for pharmacologic treatments used to manage arthropathies for Premera Bluecross members. It is intended for providers seeking policy guidance on medication coverage and relationships to other Premera pharmacotherapy policies.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pharmacotherapy of ArthropathiesGoverns pharmacy and medical coverage for pharmacologic treatments of arthropathies, including agent- and indication-specific medical necessity, site-of-service review, step and preferred-product sequencing, and related prior authorization considerations for Premera Bluecross plans.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-08-01Pharmacotherapy of Inflammatory Bowel DisorderMedical and pharmacy coverage and site-of-service, prior authorization, and step-therapy rules for pharmacologic treatment of inflammatory bowel disorders (primarily Crohn's disease and ulcerative colitis) for Premera Blue Cross members.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-02Immune Globulin TherapyDefines medical necessity, site-of-service review, and coverage criteria for intravenous and subcutaneous immune globulin therapy for Premera Bluecross members, including specific indications and administration site rules. Affects providers who order/administer IVIG/SCIG and submit prior authorization for members.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Antidepressants: Pharmacy Medical Necessity Criteria for BrandsDefines when brand-name second‑generation antidepressant drugs (SSRIs, SNRIs, and related agents) are considered medically necessary for treatment of anxiety and related indications for Premera Blue Cross members and guides provider prior authorization decisions.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Coverage Criteria for Excluded and Non-Formulary DrugsDefines Premera Bluecross pharmacy coverage criteria and related references for drugs that are excluded from or not on the formulary; applies to pharmacy benefit adjudication and prior authorization review processes.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Electrical Bone Growth Stimulation of the Appendicular SkeletonThis policy governs coverage of noninvasive electrical bone growth stimulation for the appendicular skeleton (shoulder girdle, upper extremities, pelvis, lower extremities) and states when the service may be considered medically necessary or investigational; it is directed to providers submitting claims or prior authorization requests to Premera Bluecross.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Interspinous and Interlaminar Stabilization/DistractionDefines Premera Bluecross coverage stance and criteria for interspinous and interlaminar spacer devices used to treat lumbar spinal stenosis and related procedures; intended for providers submitting claims or prior authorization requests.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Intra-Articular Hyaluronan Injections for OsteoarthritisDefines Premera Bluecross coverage stance for intra-articular hyaluronan (viscosupplementation) injections for osteoarthritis, specifying knee injections as not medically necessary and injections in all other joints as investigational; intended for providers submitting claims or prior authorizations.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medical Necessity Criteria and Dispensing Quantity LimitsDefines prior authorization, step therapy, and dispensing quantity limits for drugs on the Premera Metallic closed formulary (Rx plans M1, M2, M4) and applies to providers submitting pharmacy requests for those members.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medical Necessity Criteria and Dispensing Quantity LimitsRules for prior authorization, step therapy, and dispensing quantity limits that apply to the Individual/Small Group/Student ISHIP Metallic closed formulary (Rx plans M1, M2, M4) for Premera Bluecross members.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medical Necessity Criteria and Dispensing Quantity LimitsDefines prior authorization, step therapy, and dispensing quantity limits for drugs under the Individual/Small Group/Student ISHIP Metallic closed formulary (Rx plans M1, M2, M4) and explains applicability to members and providers.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medical Necessity Criteria for Pharmacy EditsDefines medical necessity and prior authorization criteria for medications in the plan's pharmacy benefit prior authorization program; applies to providers submitting pharmacy prior authorization requests under Premera Bluecross.All Premera Bluecross updates
- Prior AuthClinical/Medical PolicyEff. 2026-07-01Medical Pharmacologic Treatment of Multiple SclerosisDefines medical necessity, site-of-service review, and coverage criteria for specified IV and injectable disease-modifying therapies for multiple sclerosis for Premera Bluecross members; applies to providers requesting medical-benefit coverage and prior authorization for listed MS drugs.All Premera Bluecross updates
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Tool Description
Search Premera Bluecrossprior authorization policies by drug name, procedure, or policy title. Results include any policy that mentions prior authorization requirements (drug coverage criteria, imaging guidelines, site-of-service rules) not just documents titled “prior authorization.” Every result links to a full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
Filter by payer, specialty, policy type, or effective year; or search directly for a drug (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee arthroplasty”), or a policy number.
Coverage spans 110+ payers. Jump straight to the busiest prior-auth publishers: UnitedHealthcare, Cigna, Aetna, Anthem, and Centene. You can also browse the full policy updates feed.
Pair a prior-auth search with the billing code lookup to confirm the CPT or J-code on the claim, the payer lookup for plan footprint, and payer profiles for contacts and coverage context.
FAQ
Type a drug name (“Wegovy,” “Ozempic”), a procedure (“MRI,” “knee”), or a policy title into the search bar. Filter results by payer, specialty, policy type, or effective year. Open any result for the full policy page with clinical criteria, covered billing codes, documentation requirements, and effective dates.
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