March 2020

March 2020

In addition to the summary of monthly changes below, please also review our monthly Bulletin for recent and upcoming changes to our medical and dental policies, and associated changes to pre-authorization requirements. The Medical Policy Manual includes a list of recent updates and archived policies.

Medication policy updates

Listed below is a summary of medication policy changes. View our June 2020 newsletter for details.

Archived medication policy effective March 15, 2020:

  • Non-preferred colchicine products, dru615

Pre-authorization updates

The following changes will be made to our pre-authorization lists effective March 1, 2020:

Commercial Pre-authorization List

  • Ventral Hernia Repair (Surgery #12.03)

    • Pre-authorization for CPT 15734 required only with diagnosis code K43.0, K43.1, K43.6 or K43.7 for component separation technique

Uniform Medical Plan Pre-authorization List

  • Physical therapy, speech therapy, occupational therapy (PT/ST/OT)
    • CPT 92507, 92508, 92521-92524, 92526, 92597, 92607-92610, 92626, 92627, 92630, 92633, 95831-95834, 95851, 95852, 96105, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032-97036, 97039, 97110, 97112, 97113, 97116, 97127, 97129, 97130, 97139, 97140, 97150, 97161-97168, 97530, 97533, 97542, 97750, 97755, 97760, 97761, 97763, 97799; HCPCS G0151, G0152, G0157-G0160, G0283, G0515, S8950, S9128, S9129, S9131, S9152
  • Treatment of chronic migraine and chronic tension-type headache
    • CPT 97140
  • Ventral Hernia Repair (Surgery #12.03)

    • Pre-authorization for CPT 15734 required only with diagnosis code K43.0, K43.1, K43.6 or K43.7 for component separation technique

Medicare Pre-Authorization List

  • Cosmetic and Reconstructive Surgery (Medicare Surgery #12)
    • Pre-authorization for CPT 15734 required only for component separation technique performed for incisional or ventral hernias diagnosis codes K43.0, K43.1, K43.6 or K43.7
  • Multimarker and Proteomics-based Serum Testing Related to Ovarian Cancer (Medicare Laboratory #60)

    • 81500

Preservice review of outpatient services for Boeing members

Beginning for dates of service on or after March 1, 2020, preservice review for certain outpatient services will be available through eviCore healthcare (eviCore) for some Boeing group members covered by Blue Cross and Blue Shield of Illinois (BCBSIL).

This change will impact BCBSIL Boeing members with the following prefixes on their member ID cards: BBE, BHP, BNK, BRG and BYR.

Preservice reviews of medical necessity can occur for the outpatient service categories listed below. View the complete list of the CPT codes in the Clinical Guidelines sections (indicated in parentheses below) and select BCBSIL - Commercial.

  • Advanced imaging (Cardiology and Radiology)
  • Genetic testing (Laboratory Management)
  • Joint and spine surgery (Musculoskeletal: Advanced Procedures)
  • Pain management (Musculoskeletal: Advanced Procedures)
  • Radiation therapy (Radiation Oncology)
  • Cardiology (Cardiology and Radiology)
  • Sleep studies (Sleep Management)

The preservice reviews are for medical necessity which will be member liability, if denied. If a preservice review is not done prior to services being rendered, the claim will be denied and records will be ordered to be reviewed post- service.

You can request preservice review from eviCore for these members for dates of service on or after March 1, 2020, for the categories listed above now (except requests for cardiology and sleep studies can only be submitted beginning March 1, 2020). Submit requests online or by phone:

  • Online: The eviCore web portal is the quickest way to submit requests for these members, check the status of requests, review guidelines and more.
  • By phone: You can also call eviCore at 1 (855) 252 1117 between 7 a.m. and 7 p.m. (CT), Monday through Friday. Note: At the end of February 29, 2020, BCBSIL will discontinue using AIM Specialty Health (AIM) for advanced imaging preapprovals for these members.