Update to Current Procedural Terminology (CPT®) Codes for Prior Authorization for Medicare Members

May. 04, 2021

What’s Changing: Blue Cross and Blue Shield of Montana (BCBSMT) is changing prior authorization requirements for Medicare and HMK members, to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA).

Important Reminder: Always check eligibility and benefits first through the Availity® Learn more about third-party links 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, 2021 - Removal of Advanced Imaging codes previously reviewed by eviCore
  • July 1, 2021 - Removal of Genetic Testing codes previously reviewed by eviCore
  • July 1, 2021 - Adding Genetic Testing codes to be reviewed by eviCore
  • July 1, 2021 - Adding Specialty Drug codes to be reviewed by eviCore

More Information: For a revised list of codes go to the Predetermination and Preauthorization section of our provider website.

Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. 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 2020 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.

Current Procedural Terminology (CPT®) Code

Action/Description

Members Impacted

Effective Dates

PA via AIM® or eviCore or BSBSTX

77065, 77066, 77067, G0279

Removed: Radiology Therapy

Medicare, Medicaid

July 1, 2021

eviCore

0098U, 0099U, 0100U

Removed: Lab/Molecular Genetics

Medicare, Medicaid

July 1, 2021

eviCore

0242U, 0244U, 0245U, 0246U

Added: Lab/Molecular Genetics

Medicare, Medicaid

July 1, 2021

eviCore

E1399

Removed: Sleep Medicine

Commercial

April 16, 2021

AIM

C9399, J3490, J7353

Added: Specialty Drug

Medicare, Medicaid

July 1, 2021

eviCore

E0764

Added: Functional Neuromuscular Stimulator (FNMES)

Commercial

July 1, 2021

BCBSTX