Reminder: Prior authorization requirements expanding for Medicare Advantage and BCN commercial on Jan. 1

We’re expanding our prior authorization requirements for Medicare Plus Blue℠, Blue Care Network commercial and BCN Advantage℠ members. For the procedure codes listed below, you’ll need to complete questionnaires in the e-referral system when you submit prior authorization requests for dates of service on or after Jan. 1, 2022.

We’ll update related documents to reflect this change before Jan. 1.

For Medicare Plus Blue members

Most of the procedure codes below already require prior authorization for BCN commercial and BCN Advantage members. But this requirement is new for Medicare Plus Blue members for requests submitted for dates of service on or after Jan. 1.

For BCN commercial and BCN Advantage members

The procedure codes below require prior authorization for BCN commercial and BCN Advantage, but aren’t associated with a questionnaire in the e-referral system. For dates of service on or after Jan. 1, you’ll need to complete a questionnaire when you request prior authorization for these codes.

For Medicare Plus Blue, BCN commercial and BCN Advantage members

For requests submitted for dates of service on or after Jan. 1, these procedure codes will require prior authorization for Medicare Plus Blue, BCN commercial and BCN Advantage members.

^aThis procedure code currently requires prior authorization for BCN commercial and BCN Advantage members. For dates of service on or after Jan. 1, 2022, this code will be associated with the new Blepharoplasty of the lower lid questionnaire. (For dates of service prior to Jan. 1, 2022, this code is associated with the Cosmetic or reconstructive surgery questionnaire.)

None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.