
Procedures Managed by eviCore for Blue Cross
For Blue Cross PPO (commercial) members
(for dates of service on or after Jan. 1, 2018)
Providers must obtain authorization from eviCore healthcare for:
- Outpatient interventional pain management
- Inpatient and outpatient lumbar spinal fusion surgery
- Outpatient radiation therapy (oncology)
Refer to the resources below for more information:
- Procedures that require authorization by eviCore healthcare (PDF) – List of procedure codes eviCore reviews
- Guidelines for services reviewed by eviCore healthcare for Medicare Plus BlueSM PPO and Blue Care Network (PDF) – How to handle different types of authorization requests
For Blue Cross Medicare Plus BlueSM PPO members
Providers must obtain authorization from eviCore healthcare for:
- Inpatient post-acute care services
- Outpatient interventional pain management
- Inpatient and outpatient lumbar spinal fusion surgery
- Outpatient radiation therapy (oncology)
- Outpatient physical and occupational therapy services
Refer to the resources below for more information:
- Procedures that require authorization by eviCore healthcare (PDF) – List of procedure codes eviCore reviews
- Guidelines for services reviewed by eviCore healthcare for Medicare Plus BlueSM PPO and Blue Care Network (PDF) – How to handle different types of authorization requests
- Sample PT-OT authorization form for Medicare Plus BlueSM PPO (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
- corePathSM model of therapy authorization (PDF) – Introduces the new, streamlined authorization process for physical and occupational therapy visits
- FAQ about corePathSM model of therapy authorization (PDF) – Questions and answers from corePath model of therapy authorization training sessions
For related information on:
- Care management requirements for various services, refer to the Provider Toolkit page at bcbsm.com. Look under the "Care management" heading.
- Authorization requirements for other procedures, refer to the Authorization Requirements & Criteria page in the Blue Cross section of this website
- Drugs covered under the medical benefit, visit the Medical Benefit Drugs – Pharmacy page in the Blue Cross section of this website