CBI coding updates, physician drug benefit changes + gender affirming services inquiry
Do you provide gender-affirming services?
Please tell us whether you offer gender-affirming services by filling out this form!
We will be updating the Alliance’s provider directories to include which in-network providers offer these services, in compliance with APL 24-018. This information will also help our members who are seeking gender-affirming care find the right providers.
Please watch for future Alliance policies and procedures in the Alliance Provider Manual (if applicable) pertaining to this APL. Learn more on our website.
Depression Screening for Adolescents and Adults code updates
There is a coding update to the Care-Based Incentive (CBI) measure Depression Screening for Adolescents and Adults, effective retroactively starting Jan. 1, 2025.
The LOINC code for the Edinburgh Postnatal Depression Scale (EPDS) screening is now 99046-5.
Any previously submitted LOINC codes for EPDS screenings will need to be resubmitted via the Data Submission Tool (DST). If you have any questions, please email [email protected].
Physician administered drugs changes to know, effective June 1, 2025
The Alliance has made changes to physician administered drug benefits. You can find prior authorization (PA) criteria on our website.
The changes are as follows:
| HCPCS Code | Drug | Change | Preferred Drug |
| Q5147 | Pavblu (aflibercept-ayyh) | New PA Criteria | Avastin (bevacizumab) |
| Q5149 | Enzeevu (aflibercept-abzv) | New PA Criteria | Avastin (bevacizumab) |
| Q5150 | Ahzantive (aflibercept-mrbb) | New PA Criteria | Avastin (bevacizumab) |
| Q5124 | Byooviz (ranibizumab-nuna) | Modified PA Criteria | Avastin (bevacizumab) |
| J2267 | Omvoh (mirkizumab-mrkz) | Modified PA Criteria | Remicade (infliximab) |
| J2327 | Skyrizi (risankizumab-rzaa) | Modified PA Criteria | Remicade (infliximab) |
| J3301 | triamcinolone acetonide (Kenalog-10, Kenalog-40) | New PA Criteria- for hair loss requires a diagnosis of alopecia areata |
The Alliance has updated the following pharmacy policies. To request a copy, please call the Alliance Pharmacy Department at 831-430-5507.
- 403-1103: Pharmacy Authorization Request Review Process
- 403-1104: Mission, Composition and Functions of the Pharmacy and Therapeutic Committee
- 403-1109: Non-FDA Approved Drugs and Herbal Remedies
- 403-1112: Therapeutic Equivalence of Generic Drugs
- 403-1141: Physician/Facility-Administered Drugs Requiring Prior Authorization
- 403-1142: Biosimilars
- 403-1146: Drug Waste Reimbursement Policy
- 403-1151: Home Infusion Policy
- 403-1154: Naloxone Distribution Program
