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:

• July 1, 2022 – Removal of one Molecular Genetic Lab Testing code previously reviewed by eviCore
• July 1, 2022 – Replacement of Molecular Genetic Lab Testing codes reviewed by eviCore
  

More Information: Refer to the updated Preauthorization CPT Code Lists section in the Preauthorization 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.