Additional cardiology codes will require prior authorization for commercial members, starting May 11

For dates of service on or after May 11, 2024, these additional cardiology codes will require prior authorization by Carelon Medical Benefits Management for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members:

• *0795T
• *0796T
• *0797T

Starting May 11, Carelon will use the Blue Cross and BCN medical policy titled Leadless Cardiac Pacemakers as the criteria for making determinations on prior authorization requests. To access this policy, open the Medical Policy Router Search page on bcbsm.com, enter the name of the policy in the Policy/Topic Keyword field and press Enter.

You’ll be able to access Carelon’s clinical criteria for these procedures, when available, on the Current Cardiology Guidelines** page of the Carelon website.

Additional information

By May 11, we’ll update this document to include the previously mentioned codes.

For more resources related to the cardiology procedures that require prior authorization, refer to these webpages at ereferrals.bcbsm.com:

• Blue Cross Cardiology Services
• BCN Cardiology Services

**Blue Cross Blue Shield of Michigan and Blue Care Network don’t own or control this website.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.