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February 2019

Prior authorization changes coming to AIM authorization program for MAPPO members

Beginning May 1, 2019, the PPO radiology management program, administered by AIM Specialty Health, will be adding a cardiology and in-lab sleep study prior authorization program for Medicare Plus BlueSM PPO members. This includes UAW Retiree Medical Benefits Trust members with Medicare Plus Blue coverage.

The additional cardiac procedures for Medicare Plus Blue members will include:

Percutaneous coronary intervention

  • *92920
  • *92924
  • *92928
  • *92933
  • *92937
  • *92943

 Diagnostic coronary catheterization

*93454 through *93461

In addition, Blue Cross Blue Shield of Michigan will require prior authorization for in-lab sleep testing by in-state providers for Medicare Plus Blue. Preapproval must be obtained for the following procedure codes:

  • *95805
  • *95807
  • *95808
  • *95810
  • *95811

The in-lab sleep study program is the same as the program currently in place for commercial PPO members.

All authorized sleep study services should be performed at a laboratory or center accredited by the American Academy of Sleep Medicine or the Joint Commission. Also, all TRUST providers performing sleep study services for both Medicare Plus Blue and Blue Cross PPO commercial members must be certified in sleep medicine by a board recognized by Blue Cross.

URMBT commercial PPO members are excluded from the prior authorization requirement by AIM Specialty Health for expanded cardiology services described above.

Lastly, there are new prior authorization procedure codes for the AIM high-tech radiology program (breast MRI). These new codes, which are required for both Blue Cross commercial PPO and Medicare Plus Blue PPO members, are as follows:

  • *77046 through *77049

All cardiology, in-lab sleep study and high-tech radiology procedure codes will require prior authorization for both office settings and hospital outpatient locations. A list of these codes will be available on e-referral in May 2019. You may also refer to Blue Cross’ online provider manuals.

You can request authorization through AIM’s provider portal at aimspecialtyhealth.com or by contacting AIM at 1-800-728-8008.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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