2021 Commercial Preauthorization Code Lists Now Available on the Provider Website
We have added 2021 Commercial preauthorization code lists to the provider website. Providers can verify Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) code-specific preauthorization requirements for the following:
These lists include CPT® and/or HCPCS codes related to services/categories for which benefit preauthorization may be required. These lists are not exhaustive and are subject to change based on medical policy review and new code updates.
The presence of codes on these lists does not necessarily indicate coverage under the Member benefits contract. Member contracts differ in their benefits. Always check eligibility and benefits first, prior to rendering services. Not all requirements apply to each BCBSMT benefit plan.
If BCBSMT requires preauthorization for the service or CPT/HCPCS code(s), you will still need to submit the preauthorization request.
How to Submit a Preauthorization
The following outlines the process for providers to submit preauthorization requests for services requiring a preauthorization.
Check patient eligibility and benefits:
Use Availity® or your preferred vendor or call the number on the back of the Member’s ID card to check eligibility and benefits.
Services requiring preauthorization through BCBSMT:
- Submit via Availity Authorizations & Referrals . To learn more, visit Availity Authorizations & Referrals.
- Call the phone number listed on the member’s ID card.
Services requiring preauthorization through AIM Specialty Health® (after Jan. 1, 2021):
- Submit requests via the AIM Provider Portal
- Call the AIM Contact Center at 800-859-5299
Provide the following information:
- Patient’s medical or behavioral health condition
- Proposed treatment plan
- Date of service, estimated length of stay (if the patient is being admitted)
- Patient ID and name/date of birth
- Place of treatment
- Provider NPI, name and address
- Diagnosis code(s)
- Procedure code(s) (if applicable)
After the request is submitted, the service or drug is reviewed to determine if it:
- Is covered by the health plan, and
- Meets the health plan’s definition of “medically necessary.”
The results are then sent to the provider and member.
The process of submitting benefit preauthorization requests through, eviCore healthcare for Healthy Montana Kids (HMK), or other vendors has not changed.
Have additional questions? Contact your Provider Network Consultant for assistance.
Checking eligibility and/or benefit information and/or the fact that a service has been preauthorized 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 or contract of coverage applicable on the date services were rendered. If you have any questions, please call the number on the member’s ID card.
AIM Specialty Health (AIM) is an operating subsidiary of Anthem, Inc., an independent specialty medical benefits management company that provides utilization management services for BCBSMT.
CPT copyright 2020 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. BCBSMT makes no endorsement, representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions about the products or services provided by such vendors, you should contact the vendor(s) directly.