Prior Authorization Changes for Medicare Advantage Members

December 18, 2023

What’s Changing: Blue Cross and Blue Shield of Montana is changing prior authorization requirements for Medicare Advantage and Healthy Montana Kids members, to reflect new, replaced or removed codes due to 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 (HCPCS) code changes from the Centers for Medicaid & Medicare Services.

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.

A summary of changes is included below:

  •  Jan. 1, 2024 – Removal of Magellan Electro Convulsive Therapy codes previously reviewed by BCBSMT
  • April 1, 2024 – Addition of lab codes reviewed by eviCore healthcare (includes HMK)

More Information: For a revised list of codes go to the Prior Authorization Requirements section of our provider website.

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 (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Availity is a trademark of Availity, L.L.C., 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 (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSMT.

The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.