January 2019
Starting Feb. 1, eviCore managing two radiopharmaceutical drugs
For dates of service on or after Feb. 1, 2019, the following radiopharmaceutical drugs need authorization through eviCore healthcare:
- Lutathera® (lutetium Lu 177 dotatate, HCPCS code A9513)
- Xofigo® (radium Ra 223 dichloride, HCPCS code A9606)
This applies to members covered by:
- Blue Cross Blue Shield of Michigan PPO (commercial) and Blue Cross Medicare Plus BlueSM PPO
Note: Currently, eviCore manages procedures associated with code A9606 for Blue Cross and Medicare Plus Blue members. On Feb. 1, eviCore will begin managing procedures associated with code A9513.
- BCN HMOSM commercial and BCN AdvantageSM
Note: Lutathera was managed for BCN HMO members under the prior authorization program for drugs covered under the medical benefit. Currently, eviCore manages procedures associated with code A9513 (currently C9031) for BCN Advantage members. For BCN HMO members, C codes aren’t payable. However, services associated with the administration of an approved treatment plan with Lutathera are payable for BCN HMO members. On Feb. 1, eviCore will begin managing procedures associated with code A9606 for both BCN HMO and BCN Advantage.
We’ll update the Procedures that require authorization by eviCore healthcare document before the effective date of the change.
Send authorization requests to eviCore online or by telephone at 1-855-774-1317.
Note: These changes don’t apply to MESSA members.
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