New and updated questionnaires in e-referral system

On Aug. 28 and Sept. 11, 2022, we added and updated questionnaires in the e-referral system. We also added and updated the corresponding preview questionnaires on the ereferrals.bcbsm.com website.

As a reminder, we use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your prior authorization requests.

New questionnaires

We added the following questionnaires for BCN commercial and BCN Advantage℠ members:

• Breast elastography — For adult members. Opens for procedure codes *76391, *76981 and *76982.
• Responsive neurostimulator/deep brain stimulation trigger — For pediatric and adult members. Opens for procedure codes *61863, *61864, *61868, *61880, *61885 and *61888.
• Responsive neurostimulation for the treatment of refractory partial epilepsy — For adult members. Opens for procedure codes *61863, *61864, *61868, *61880, *61885, *61888 and *95836.

Updated questionnaires

We updated the following questionnaires:

• Cosmetic or reconstructive surgery — For adult Medicare Plus Blue℠, BCN commercial and BCN Advantage members. This questionnaire now opens for procedure codes *21742, *21743 and *36468.
• Deep brain stimulation — For adult Medicare Plus Blue, BCN commercial and BCN Advantage members. This questionnaire no longer opens for procedure code *61850 because this code no longer requires prior authorization.
• Dermal chemical peels — For adult and pediatric BCN commercial and BCN Advantage members. We updated a question.
• Hyperbaric oxygen therapy — For adult and pediatric BCN commercial and BCN Advantage members. There are separate questionnaires for BCN commercial and BCN Advantage. We updated questions in both questionnaires.
• Orthognathic surgery — For adult and pediatric BCN commercial and BCN Advantage members. We updated a question.
• Prostatic urethral lift — For adult BCN commercial and BCN Advantage members. We updated a question.
• Varicose vein — For adult BCN commercial and BCN Advantage members. This questionnaire now opens for procedure code *36466. It no longer opens for procedure codes *37765, *37766 or *36468. Note that procedure codes *37765 and *37766 no longer require prior authorization.

Preview questionnaires

You can access preview questionnaires at ereferrals.bcbsm.com. You’ll see the questions you'll need to answer in the questionnaires that open in the e-referral system so you can prepare your answers ahead of time.

To find the preview questionnaires:

• Click on Blue Cross and then click on Authorization Requirements & Criteria. Scroll down and look under the “Authorization criteria and preview questionnaires – Medicare Plus Blue” heading.
• Click on BCN and then click on Authorization Requirements & Criteria. Scroll down and look under the “Authorization criteria and preview questionnaires” heading.

Authorization criteria and medical policies

The pertinent authorization criteria and medical policies are also available on the Authorization Requirements & Criteria pages.