Inpatient lumbar spinal fusion procedures require two authorizations

Two authorizations are needed for inpatient spinal fusion procedures that require clinical review: one authorization for the procedure and one for the admission.

The medical necessity for the procedure is reviewed by eviCore. The facility must request an inpatient authorization through e-referral for the inpatient stay. Blue Cross Blue Shield of Michigan will then review appropriateness of the setting.

For an inpatient lumbar spinal fusion procedure, the facility needs to load an authorization with procedure code *99222 in e-referral. Don’t use the lumbar spinal fusion procedure codes or you’ll receive a block message.

If the inpatient authorization for a lumbar spinal fusion procedure requires an admission date change, email e-referralinquiries@bcbsm.com.

Don’t contact eviCore to convert an existing outpatient authorization to an inpatient authorization, as they will redirect you to Blue Cross.