Updates to the Blue Cross Blue Shield of Montana Medicare Advantage Preauthorization List Effective January 1, 2016

Oct. 12, 2015

On January 1, 2016 the Blue Cross Blue Shield of Montana (BCBSMT) Medicare Advantage (PPO) plan and Medicare Advantage HMO plan will have some changes to the list of procedures requiring preauthorization. Please see the updated preauthorization list here.

As a reminder, our automated preauthorization tool — AerialTM iExchange® (iExchange) —supports direct submission and provides online approval of benefits for inpatient admissions, as well as select outpatient, pharmacy and behavioral health services 24 hours a day, seven days a week — with the exception of every third Sunday of the month when the system will be unavailable from 10 a.m. to 2 p.m. (Mountain Time). iExchange is accessible to physicians, professional providers and facilities contracted with BCBSMT. For more information or to set up a new account, complete and submit the online enrollment form.

Please contact your Provider Network Representative if you have any questions and/or if you need additional information.

  • Christy McCauley, 406-437-6068, Christy_McCauley@bcbsmt.com (West region)
  • Leah Martin, 406-437-6162, Leah_Martin@bcbsmt.com (West region)
  • Floyd Khumalo, 406-437-5248, thamsanqa_F_khumalo@bcbsmt.com (Central region)
  • Susan Lasich, 406-437-6223, Susan_Lasich@bcbsmt.com (East region)
  • Troy Smith, 406-437-5214, Troy_Smith@bcbsmt.com (East Region)

Services Requiring Preauthorization, the attending physician must obtain preauthorization for the services listed below except in an emergency.

Medical/Surgical
Acute inpatient hospital stays
Ambulance (A0430, A0431, A0435, A0436)
DME greater than $2500 (E0652, K0822, E0748, E0747, L8680, E0760, K0861)
Home health care
Inpatient rehabilitation
Long term care hospital (LTCH)
Medications (J1459, J1556, J1557, J1559, J1561, J1562, J1566, J1568, J1569, J1572, 90283, 90284, J2357, J1745, J0490, Q2043, J3262, J2323, J9035, C9257, J9310, J0585, J0587, J2505, J9228, C9027, C9453, J0881, J0882)
Organ transplants other than ocular and kidney
Plastic, reconstructive and aesthetic surgery (15775-15835)
Prosthetics/orthotics greater than $2500
Skilled nursing facility (SNF)
Advanced radiology - including PET scans, CT Scans, MRIs require prior authorization inclusive of the following codes.
  • PET Scans (78459, 78491, 78492, 78608, 78609, 78811 to 78816)
  • Breast MRIs (77058 through 77059)
  • CT Cardiology studies (75571 through 75574)
GI Radiology services including 91110, 91111
Behavioral Health
All inpatient stays
Partial hospitalization program (PHP)
Outpatient services:
  • ECT - 90870
  • rTMS - 90867, 90868
  • Psychological testing - 96101, 96102, 96103
  • Neuropsychological testing - 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96125