For Blue Cross commercial members

Providers must obtain authorization from eviCore^® healthcare for outpatient radiation oncology.

Note: eviCore managed interventional pain management procedures and lumbar spinal fusion surgeries for Blue Cross commercial members through Dec. 31, 2020. For dates of service on or after Jan. 1, 2021, these services are managed by TurningPoint Healthcare Solutions LLC; refer to the Blue Cross Musculoskeletal Services page on this website for more information.

Refer to the resources below for more information:

• Procedures that require authorization by eviCore healthcare (PDF) – List of procedure codes eviCore reviews
• Services reviewed by eviCore for Blue Cross and BCN (PDF) – How to handle different types of authorization requests
• Authorizations Quick Reference Guide (PDF) – How to submit a request to eviCore
• eviCore coding guidelines for radiation oncology* (PDF)
• Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about utilization management programs

For Medicare Plus Blue^SM members

Providers must obtain authorization from eviCore healthcare for:

• Outpatient radiation oncology
• Outpatient physical and occupational therapy services

Note: eviCore managed interventional pain management procedures and lumbar spinal fusion surgeries for Medicare Plus Blue members through Dec. 31, 2020. For dates of service on or after Jan. 1, 2021, these services are managed by TurningPoint Healthcare Solutions LLC; refer to the Blue Cross Musculoskeletal Services page on this website for more information.

Refer to the resources below for more information:

• Procedures that require authorization by eviCore healthcare (PDF) – List of procedure codes eviCore reviews
• Services reviewed by eviCore for Blue Cross and BCN (PDF) – How to handle different types of authorization requests
• Authorizations Quick Reference Guide (PDF) – How to submit a request to eviCore
• Oncology: For CAR-T cell therapy, medical oncology and radiation oncology (PDF) - Includes information about utilization management programs
• Sample PT-OT authorization form for Medicare Plus Blue^SM (PDF) – Identifies mandatory fields and provides explanation of some field contents for the forms
• FAQ about eviCore physical therapy (PDF) – Answers common questions about the eviCore physical therapy program
• Tips for improving treatment efficiency, for members undergoing physical therapy (PDF)
• corePath^SM model of therapy authorization (PDF) – Introduces the new, streamlined authorization process for physical and occupational therapy visits
• FAQ about corePath^SM model of therapy authorization (PDF) – Questions and answers from corePath model of therapy authorization training sessions
• Outpatient PT, OT and ST, and physical medicine services by chiropractors and athletic trainers: For authorization determinations (PDF)
• Musculoskeletal Specialized Therapy Program* (PDF) – Questions and answers about PT practitioner performance summary and provider categories
• eviCore coding guidelines for radiation oncology* (PDF)

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