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March 2025

Questionnaire changes in e-referral system

On Dec. 22, 2024, and Feb. 2, 2025, we updated and deleted questionnaires in the e-referral system.

We’ve updated the Authorization criteria and preview questionnaires document on the ereferrals.bcbsm.com website to reflect these changes.

Please remember, 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.

What changed Dec. 22, 2024

We updated the following questionnaires in the e-referral system.

Questionnaire

Opens for

Updates

Cosmetic or reconstructive surgery

Blue Care Network commercial
  • The questionnaire no longer opens for procedure codes *15780, *15782, *15783, *15786 and *15829 because they aren’t covered services.
  • The questionnaire no longer opens for procedure code *15819 because it’s been retired by the American Medical Association.
  • The questionnaire no longer opens for procedure codes *17380 and *56620. These procedure codes will continue to require prior authorization.
  • The questionnaire opens for procedure codes *21137 and *21138.

Pregnancy termination 4

BCN Advantage℠

Procedure codes *59812, *59820, *59821, *59830 and *59870 were removed and no longer require prior authorization.

We removed the following questionnaires from the e-referral system.

Note: The listed procedure codes continue to require prior authorization.

Questionnaire

Lines of business

Procedure codes

FCA elective pregnancy termination

BCN commercial members who have Healthy Blue Choices℠ POS plans

*01966, *59100, *59840, *59841, *59850, *59851, *59852, *59855, *59856, *59857, *59866, S0190, S0191, S0199, S2260, S2265, S2266, S2267

Pregnancy termination 1 — Medically necessary

BCN commercial

Pregnancy termination 3 — Elective

BCN commercial

What changed Feb. 2, 2025

We made the following changes for the lines of business listed in the second column of the table.

Service

Affected lines of business

What happened before Feb. 2

What happened starting Feb. 2

Blepharoplasty
  • Medicare Plus Blue℠
  • BCN Advantage

A custom questionnaire opened in the e‑referral system for procedure codes *15822, *15823, *67900, *67901, *67902, *67903, *67904, *67906 and *67908.

We retired the custom questionnaire for Medicare Plus Blue and BCN Advantage.

The standard questionnaire, titled Blepharoplasty and repair of brow ptosis (outpatient), now opens in the e-referral system for the procedure codes listed in the column to the left.

Percutaneous left atrial appendage closure
  • Medicare Plus Blue
  • BCN commercial
  • BCN Advantage

A questionnaire opened in the e‑referral system for procedure code *33340.

This service doesn’t require prior authorization for Medicare Plus Blue, BCN commercial or BCN Advantage.

Preview questionnaires

Preview questionnaires show the questions you’ll need to answer in the e-referral system, so you can prepare your answers ahead of time.

To find the preview questionnaires, see the document titled Authorization criteria and preview questionnaires.

You can access this document by going to ereferrals.bcbsm.com and doing the following:

  • For Medicare Plus Blue: Click on Blue Cross and then click on Prior Authorization. Scroll down and look under the “Authorization information for Medicare Plus Blue members” heading.
  • For BCN: Click on BCN, and then click on Prior Authorization & Plan Notification. Scroll down and look under the “Authorization criteria and preview questionnaires for select services” heading.

Authorization criteria and medical policies

The Authorization criteria and preview questionnaires document explains how to access the pertinent authorization criteria and medical policies.

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 2024 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
independent licensees of the Blue Cross and Blue Shield Association.