Nov. 1, 2024
We’re changing prior authorization requirements for Medicare Advantage members to reflect new, replaced or removed codes.
Changes are based on updates from utilization management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System code changes from the Centers for Medicaid & Medicare Services. Here is a summary of changes:
- Jan. 1, 2025 – Removal of medical oncology and supportive care codes previously reviewed by eviCore healthcare
- Jan. 1, 2025 – Medical oncology drug codes previously reviewed by eviCore to be reviewed by Blue Cross and Blue Shield of Montana
For a revised list of codes for Medicare Advantage plans, refer to prior authorization requirements.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor portal prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the AMA.
Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSMT. eviCore healthcare. is an independent specialty medical benefits management company that provides utilization management services for BCBSMT. BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.