Jan. 28, 2026
We’re changing prior authorization or recommended clinical review directions that may apply to some commercial and government program members.
Changes are based on updates from utilization management prior authorization assessment, Current Procedural Terminology (CPT®) code changes released by the American Medical Association or Healthcare Common Procedure Coding System code changes from the Centers for Medicare & Medicaid Services.
For some services and members, prior authorization may be required through Blue Cross and Blue Shield of New Mexico. Utilization management and related services for Medicare Advantage members will be reviewed by BCBSNM and EviCore healthcare. Carelon Medical Benefits Management will review utilization management and related services for some commercial members and members with Turquoise Care. Alacura Medical Transportation Management will review utilization management and related services for some commercial members.
These changes for commercial members begin April 1, 2026:
Addition of medical transportation management codes to be reviewed by Alacura
These changes for Turquoise Care members begin April 1, 2026:
Removal of miscellaneous codes previously reviewed by Carelon
These changes for Medicare Advantage members begin April 1, 2026:
Addition of miscellaneous codes to be reviewed by BCBSNM
These changes for commercial and Turquoise Care members begin July 1, 2026:
Addition of an advanced imaging code to be reviewed by Carelon
For more information, refer to preservice reviews.
Always check eligibility and benefits first through Availity® Essentials or your preferred vendor prior to rendering services. This step will confirm prior authorization requirements and utilization management vendors, if applicable.
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 coverage contract or guide. If you have any questions, call the number on the member's ID card.
Services performed without required 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 2025 AMA. All rights reserved. CPT is a registered trademark of the AMA.
Alacura Medical Transportation Management, LLC. is an independent company that has contracted with BCBSNM to provide utilization management services for participants with coverage through BCBSNM. 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 BCBSNM. EviCore healthcare is an independent specialty medical benefits management company that provides utilization management services for BCBSNM. Carelon Medical Benefits Management is an independent company that has contracted with BCBSNM to provide utilization management services for members with coverage through BCBSNM.
BCBSNM makes no endorsement, representations or warranties regarding third party vendors and the products and services they offer.