April 3, 2025
We’re changing prior authorization requirements that may apply to some commercial members to reflect new, replaced or removed codes. These changes are based on updates from utilization management prior authorization assessment, including Current Procedural Terminology (CPT®) code changes or Healthcare Common Procedure Coding System code changes from the Centers for Medicaid & Medicare Services.
Changes include:
- July 1, 2025 – Addition of genetic testing codes to be reviewed by Carelon Medical Management
- July 1, 2025 – Replacement of medical oncology codes to be reviewed by Carelon Medical Management
- July 1, 2025 – Addition of medical oncology codes to be reviewed by Carelon Medical Management
- July 1, 2025 – Removal of specialty drug codes previously reviewed by Blue Cross and Blue Shield of Montana
- July 1, 2025 – Addition of specialty drug codes to be reviewed by BCBSMT
More information: For code lists, refer to prior authorization and recommended clinical review.
Important reminder: Always check eligibility and benefits first through Availity® Essentials or your preferred vendor 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 don’t meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2024 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.
Carelon Medical Benefits Management (Carelon) is an independent company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT.
BCBSMT makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.