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October 2017

Here are some FEP checklists for criteria that’s required for review of medical necessity

The Blue Cross Blue Shield of Michigan Federal Employee Program® team has put together some criteria checklists. These are lists of medical documentation for criteria that’s required for review of medical necessity.

To view and use the checklists, click on the links below:

**Prior approval required for outpatient morbid obesity
***Prior approval required for preventative testing
****Prior approval required

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.
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