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October 2019

New, updated questionnaires have started opening in e-referral system

New and updated questionnaires started opening in the e‑referral system for certain procedures on Aug. 25 and Sept. 29, 2019. In addition, new and updated preview questionnaires, authorization criteria and medical policies are available on the ereferrals.bcbsm.com website.

We use our authorization criteria, medical policies and your answers to the questionnaires when making utilization management determinations about your authorization requests.

New questionnaires

Effective Aug. 25, questionnaires started opening for the first time in the e-referral system for authorization requests for BCN HMOSM and BCN AdvantageSM for the procedures listed below, which already require authorization.

Service Age Procedure code
Bariatric surgery — BCN HMO Adult and adolescents *43644, *43645, *43770, *43771, *43772, *43773, *43774, *43775, *43842, *43843, *43845, *43846, *43847, *43848, *43886, *43887, *43888 and *44130
Bone-anchored hearing aid Adult and pediatric (5 years old and older) *69714, *69715, *69717 and *69718
Cardiac rehabilitation – BCN HMO
Cardiac rehabilitation – BCN Advantage
Adult and pediatric *93797 and *93798 (for select diagnoses)
Pregnancy termination – BCN HMO
Pregnancy termination – BCN Advantage
Adult *01966, *59100, *59840, *59841, *59850, *59851, *59852, *59855, *59856, *59857, *59866, *88304, *88305, S0190, S0191, S0199, S2260, S2265, S2266 and S2267
Pulmonary rehabilitation Adult and pediatric G0237, G0238, G0239, G0302, G0303, G0304, G0424 and S9473
Radiofrequency ablation, peripheral nerves Adult *64640
Visual training, orthotic and pleoptic Adult and pediatric *92065

Updates to existing questionnaires

In addition, updated questionnaires started opening in the e-referral system on the dates specified below for BCN HMO, BCN Advantage and Medicare Plus BlueSM PPO authorization requests (unless otherwise noted), for the following services:

  • Cervical spine surgery — Aug. 25; opens only for BCN HMO and BCN Advantage
  • Cervical spine surgery with artificial disc replacement — Sept. 29
  • Cholecystectomy (laparoscopic) — Aug. 25; opens only for BCN HMO and BCN Advantage
  • Endovascular intervention, peripheral artery — The updated questionnaire for this service was originally scheduled to open starting on July 28 for Medicare Plus Blue requests but actually started opening on Aug. 25.
  • Ethmoidectomy — Aug. 25
  • Hammertoe correction surgery — Aug. 25
  • Hip arthroplasty, total, revision — Aug. 25
  • Knee arthroplasty, total, revision — Aug. 25
  • Noncoronary vascular stents — Sept. 29
  • Sacral nerve neuromodulation/stimulation — Aug. 25
  • Sinusotomy, frontal, endoscopic — Aug. 25
  • Sleep studies, outpatient facility or clinic-based setting — Aug. 25; opens only for BCN HMO and BCN Advantage
  • Vascular embolization or occlusion of hepatic tumors (TACE/RFA) — Aug. 25

Preview questionnaires

For all of these services, you can access preview questionnaires at ereferrals.bcbsm.com. The preview questionnaires show the questions you’ll need to answer in the actual questionnaires that open in the e-referral system. This can help you prepare your answers ahead of time.

To find the preview questionnaires:

  • For BCN: Click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the Authorization criteria and preview questionnaires heading.
  • For Medicare Plus Blue: Click Blue Cross and then click Authorization Requirements & Criteria. In the Medicare Plus Blue PPO members section, look under the Authorization criteria and preview questionnaires — Medicare Plus Blue PPO heading.

Authorization criteria and medical policies

We also posted links to the pertinent authorization criteria and medical policies on the Authorization Requirements & Criteria pages.

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.