Prior Authorization Changes for Medicare Advantage and Healthy Montana Kids Members

Updated: March 26, 2024
Published: March 15, 2024

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® 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.

A summary of changes is included below:

  • July 1, 2024 – Addition of Lab codes to be reviewed by eviCore (HMK)
  • July 1, 2024 – Removal of Lab codes previously reviewed by eviCore (HMK)
  • July 1, 2024 – Addition of Speciality Drug codes to be reviewed by BCBSMT

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, 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 (eviCore) 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.