Prior Authorization Summary/Code List Archive

This page includes the prior authorization summaries and code list documents that were previously posted.

2024 Procedure Code Lists Effective 01/01/2024

• Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
• Medicare Procedure Codes Requiring Prior Authorization
• New Mexico Medicaid Procedure Codes Requiring Prior Authorization
• Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only (ASO) Members
• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured
• Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Administrative Only (ASO) Members 
• Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Fully Insured Members 

2024 Procedure Code Lists Effective 02/01/2024

• Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 03/01/2024

• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 04/01/2024

• Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
• Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only (ASO) Members
• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 05/01/2024

• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 06/01/2024

• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 07/01/2024

• Medicare Procedure Codes Requiring Prior Authorization
• New Mexico Medicaid Procedure Codes Requiring Prior Authorization
• Recommended Clinical Review - Administrative Services Only (ASO)
• Recommended Clinical Review - Fully Insured

2024 Procedure Code Lists Effective 10/01/2024

• Medicare Procedure Codes Requiring Prior Authorization

Checking eligibility and benefits and/or obtaining prior authorization is not a guarantee of payment of benefits. Payment of benefits is subject to several factors, including, but not limited to, eligibility at the time of service, payment of premiums/contributions, amounts allowable for services, supporting medical documentation, and other terms, conditions, limitations, and exclusions set forth in the member’s policy certificate and/or benefits booklet and or summary plan description. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider. If you have any questions, call the number on the member's BCBSNM ID card.