Musculoskeletal Spinal Surgery Prior Authorization Codes Updated for Commercial Members, Effective April 22, 2024 

February 21, 2024

What’s Changing: Starting April 22, 2024, prior authorization requests for spinal surgeries for some Blue Cross and Blue Shield of Montana members will now be delegated to Carelon Medical Benefits Management. This change will apply to commercial and retail members. Self-funded accounts will continue to be managed internally until plan renewal where review of these services will be optional.

Important Reminder: Always check eligibility and benefits first through the Availity® Essentials Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Prior authorization requests for these services for other members will continue to be managed by BCBSMT, until member plan renewal.

Note: All prior authorization requests for inpatient stays for spinal surgeries should continue to be submitted to BCBSMT.

When Carelon is delegated for review of a spinal surgery procedure, any request for an inpatient admission following the surgery should be submitted to BCBSMT once an approved authorization is received from Carelon.

More Information: For a revised list of all CPT codes that require prior authorization go to the Utilization Management section of our provider website. For information on how to request prior authorization, visit our website here.

CPT copyright 2023 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Checking or confirming 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 contract, guide or summary plan description, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the Health Advocate or customer service number on the member's ID card.

Carelon Medical Benefits Management (Carelon) is a separate company that has contracted with BCBSMT to provide utilization management services for members with coverage through BCBSMT.

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.