November 2021
Current Procedural Terminology (CPT®) Codes Updated for Prior Authorization for Medicare
What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA). A summary of changes is included below.
Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Changes Include:
- Jan. 1, 2022 – Removal of Medical Oncology codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Molecular Genetics codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Musculoskeletal codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Radiology codes previously reviewed by eviCore
- Jan. 1, 2022 – Addition of Radiology codes to be reviewed by eviCore
- Jan. 1, 2022 – Removal of Radiation Therapy codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Specialty Pharmacy codes previously reviewed by eviCore
- Jan. 1, 2022 – Addition of a Specialty Drug code to be reviewed by eviCore
- Jan. 1, 2022 – Removal of a Specialty Drug code previously reviewed by eviCore
- Jan. 1, 2022 – Addition of Genetic Lab codes to be reviewed by eviCore
- Jan. 1, 2022 – Removal of Physical Health codes previously reviewed by BCBSOK
More Information: For a complete and up-to-date list of codes, visit our website’s prior authorization section.
CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.
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 BCBSOK.
BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them.