November 24, 2021
What’s Changing: Blue Cross and Blue Shield of New Mexico (BCBSNM) 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).
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:
- Jan. 1, 2022 – Removal of Radiation Therapy codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Genetic Lab codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Musculoskeletal codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Radiology codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Specialty Pharmacy codes previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Medical Oncology codes previously reviewed by eviCore
- Jan. 1, 2022 – Addition of a Specialty Drug code to be reviewed by eviCore
- Jan. 1, 2022 – Removal of a Specialty Drug code previously reviewed by eviCore
- Jan. 1, 2022 – Removal of Physical Health codes previously reviewed by BCBSNM
- Jan. 1, 2022 – Addition of Genetic Lab codes to be reviewed by eviCore
- Jan. 1, 2022 – Addition of Radiology codes to be reviewed by eviCore
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.
eviCore healthcare (eviCore) is an independent specialty medical benefits management company that provides utilization management services for 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.