December 30, 2021
What’s Changing: Blue Cross and Blue Shield of New Mexico (BCBSNM) is changing prior authorization requirements that may apply for some commercial and Medicaid Blue Cross Community CentennialSM 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 Availity® or your preferred vendor, prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
Changes include:
- April. 1, 2022 – Addition of Musculoskeletal codes to be reviewed by AIM (Commercial and Medicaid)
- April 1, 2022 – Addition of Molecular Genetic Lab Testing codes to be reviewed by AIM (Commercial and Medicaid)
- April 1, 2022 – Removal of one Musculoskeletal code previously reviewed by AIM (Commercial and Medicaid)
- April 1, 2022 – Removal of Radiation Therapy/Radiation Oncology codes previously reviewed by AIM (Commercial and Medicaid)
- April 1, 2022 – Addition of Advanced Imaging /Radiology codes to be reviewed by AIM (Commercial and Medicaid)
- April 1, 2022 – Addition of Medical Oncology codes to be reviewed by BCBSNM (Medicaid only)
More Information: Refer to the updated Prior Authorization CPT Code Lists section in the Prior Authorization area of the website. The code changes will be designated with dates of removal or addition.
Avoid post-service medical necessity reviews and delays in claim processing by obtaining prior authorization before rendering services. If prior authorization is required, services performed without prior authorization or that do not meet medical necessity criteria may be denied for payment and the rendering provider may not seek reimbursement from the member.
CPT copyright 2020 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.
Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSNM.
AIM Specialty Health (AIM) is an independent company that has contracted with BCBSNM to provide utilization management services for members with coverage through BCBSNM.
The vendors are solely responsible for the products or services they offer. If you have any questions regarding any of the products or services they offer, you should contact the vendor(s) directly.