This page includes the prior authorization summaries and code list documents that were previously posted.
2025 Procedure Code Lists
-
- Home
- Network Participation
- Claims & Eligibility
Claims & Eligibility
- Education & Reference
Education & Reference
- Clinical Resources
Clinical Resources
-
Behavioral Health
- Case Management
- Childhood Obesity Provider Toolkit
- Clinical Practice Guidelines
- Clinical Quality Improvement Reference
- Diabetes Guidelines and Resources
- Health Equity and Social Determinants of Health (SDoH)
- Medical Records Documentation
- Opioid Resources
- Preventive Care Guidelines
- Quality Improvement Tip Sheets
- Tobacco Cessation Program
-
Behavioral Health
- Pharmacy Program
- Standards & Requirements
Standards & Requirements
- Standards and Requirements
- Provider Reference Manual
- CAA and Transparency in Coverage
- Telemedicine
-
Clinical Payment and Coding Policies
- Reimbursement Calculations
- Medical Policy
- Medical Policy or Prior Authorization (Out of Area)
-
Affordable Care Act (ACA)
-
ICD-10
- ANSI Version 5010
- New Mexico Provider Grievance Plan
- Employers
- Producers
- Providers
- Company Information
Prior Authorization Summary/Code List Archive
-
2024
2024 Procedure Code Lists
- 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
-
2023
2023 Procedure Code Lists Effective 01/01/2023
- 2023 Behavioral Health Procedure Codes Requiring Prior Authorization for Fully Insured and Administrative Services Only (ASO) Members Effective 01/01/2023 through 09/17/2023
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List_NM
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Fully Insured and Administrative Services Only (ASO) Members Effective 01/01/2023 through 09/17/2023
- 2023 List of Service Categories Requiring Prior Authorization
- 2023 New Mexico Medicaid Procedure Codes Requiring Prior Authorization
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members Effective 01/01/2023 through 09/17/2023
- 2023 Recommended Clinical Review List
- 2023 Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Fully Insured and Administrative Only (ASO) Members Effective 01/01/2023 through 09/17/2023
2023 Procedure Code Lists Effective 02/01/2023
- 2023 Commercial Procedure Code Lookup for commercial members
- 2023 List of Service Categories Requiring Prior Authorization
- 2023 Recommended Clinical Review List
2023 Procedure Code Lists Effective 03/01/2023
2023 Procedure Code Lists Effective 04/01/2023
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List_NM
- 2023 List of Service Categories Requiring Prior Authorization
- 2023 Medicare Procedure Codes Requiring Prior Authorization
- 2023 New Mexico Medicaid Procedure Codes Requiring Prior Authorization
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Recommended Clinical Review List
2023 Procedure Code Lists Effective 05/01/2023
2023 Procedure Code Lists Effective 06/01/2023
- 2023 Commercial Procedure Code Lookup for commercial members
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List_NM
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Recommended Clinical Review List
2023 Procedure Code Lists Effective 07/01/2023
- 2023 Commercial Procedure Code Lookup for commercial members
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Fully Insured and Administrative Services Only (ASO) Members
- 2023 New Mexico Medicaid Procedure Codes Requiring Prior Authorization
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Administrative Services Only (ASO) Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Recommended Clinical Review List
2023 Procedure Code Lists Effective 08/01/2023
- 2023 Commercial Procedure Code Lookup for commercial members
- Recommended Clinical Review - Administrative Services Only (ASO)
- Recommended Clinical Review - Fully Insured
- Recommended Clinical Review - Fully Insured and Administrative Services Only (ASO)
2023 Procedure Code Lists Effective 09/01/2023
- Recommended Clinical Review - Administrative Services Only (ASO)
- Recommended Clinical Review - Fully Insured
2023 Procedure Code Lists Effective 09/18/2023
- 2023 Behavioral Health Procedures Requiring Prior Authorization for Administrative Services Only (ASO) Members
- 2023 Behavioral Health Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Fully Insured Members
- 2023 Outpatient Medical/Surgical Procedure Codes Requiring Prior Authorization for Fully Insured Members
- 2023 Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Administrative Only (ASO) Members
- 2023 Summary of Medical/Surgical and Behavioral Health Services, and Specialty Pharmacy Drugs Requiring Prior Authorization for Fully Insured Members
2023 Procedure Code Lists Effective 10/01/2023
- 2023 New Mexico Medicaid Procedure Codes Requiring Prior Authorization
- 2023 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
2023 Procedure Code Lists Effective 11/01/2023
- Recommended Clinical Review - Administrative Services Only (ASO)
- Recommended Clinical Review - Fully Insured
2023 Procedure Code Lists Effective 12/01/2023
- 2023 Commercial Specialty Pharmacy Prior Authorization Drug List for Administrative Services Only (ASO) Members
- 2023 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
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.