Current Procedural Terminology® (CPT) Codes Updated for Prior Authorization for Medicare, Effective July 1  

04-21-22

What’s Changing: Blue Cross and Blue Shield of Oklahoma (BCBSOK) is changing prior authorization requirements for Medicare members to reflect new, replaced or removed codes due to updates from Utilization Management or the American Medical Association (AMA). A summary of changes is included below.

Important Reminder: Always check eligibility and benefits first through the Availity® Provider Portal or your preferred vendor portal, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.

Changes Include:

  • July 1, 2022 – Addition of one Outpatient Sleep code to be reviewed by eviCore
  • July 1, 2022 – Addition of two Outpatient Specialty Drug codes to be reviewed by eviCore
  • July 1, 2022 – Addition of Outpatient Specialty Drug, Susvimo, reported with codes J3590 or C9399 to be reviewed by eviCore
  • July 1, 2022 – Addition of Outpatient Specialty Drugs Cortophin and Vyvgart, reported with codes J3490, J3590 or C9399 to be reviewed by eviCore

More Information: For a complete and up-to-date list of codes, go to our prior authorization section on our Medicare webpage.

 

CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Checking eligibility and/or benefit information and/or obtaining prior authorization is not a guarantee of payment. Benefits will be determined once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of coverage, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card.

eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for BCBSOK.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK.