More BCN questionnaires to open on June 23 in e-referral
Starting June 23, 2019, questionnaires will open in the e-referral system for BCN authorization requests for the procedures listed below, which already require authorization. The questionnaires will open for both BCN HMOSM (commercial) and BCN AdvantageSM requests unless otherwise noted.
| Service | Age | Procedure codes |
|---|---|---|
| Artificial heart, total | Adult and pediatric | *0051T, *0052T, *0053T, *33927, *33928, *33929, *33992 and *33993 |
| Bariatric surgery (for BCN Advantage) | Adult | *43644, *43645, *43659, *43770, *43771, *43772, *43773, *43774, *43775, *43842, *43843, *43845, *43846, *43847, *43848, *43886, *43887, *43888 and *44130 |
| Biofeedback, non-behavioral health (for BCN Advantage) | Adult | *90901 and *90911 (for select diagnoses) |
| Biofeedback, non-behavioral health (for BCN HMO) | Adult and pediatric | *90901 and *90911 (for select diagnoses) |
| Breast implant management | Adult | *19325, *19328 and *19330 |
| Breast reconstruction | Adult | *11920, *11921, *11922, *19316, *19324, *19340, *19342, *19350, *19355, *19357, *19361, *19364, *19366, *19367, *19368, *19369, *19370, *19380, *19396, S2066, S2067 and S2068 |
| Breast reduction, adolescent | Pediatric | *19318 |
| Breast reduction, adult | Adult | *19318 |
| Chemical peels | Adult and pediatric | *15788, *15789, *15792 and *17362 |
| Cosmetic or reconstructive surgery | Adult and pediatric | *0479T, *0480T, *0491T, *0492T, *11950, *11951, *11952, *11954, *15775, 15776, *15780, *15781, *15782, *15783, *15786, *15787, *15820, *15821, *15824, *15825, *15826, *15828, *15829, *15876, *15877, *15878, *15879, *17340, *17380, *21083, *21087, *21172, *21275, *21280, *21282, *30620, *36468, *36469, *54660, *56620, *67909, *67911, G0429, Q2026, Q4100 and S0800 |
| Dental anesthesia or repair of trauma to natural teeth | Adult and pediatric | *00170 and *41899 |
| Enteral nutrition | Adult and pediatric | B4034, B4035, B4036, B4081, B4082, B4083, B4087, B4088, B4102, B4103, B4104, B4105, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9002, B9998, S9341, S9342 and S9343 |
| Excess skin removal | Adult | *15832, *15833, *15834, *15835, *15836, *15837, *15838 and *15839 |
| Mastectomy for gynecomastia | Adult | *19300 |
| Oral surgery | Adult and pediatric | *40525, *40527, *40700, *40701, *40702, *40720, *40761, *40808, *40810, *40812, *40816, *40818, *40840, *40842, *40843, *40844, *40845, *40899, *41800, *41805, *41806, *41820, *41821, *41822, *41823, *41825, *41826, *41827, *41828, *41830, *41850, *41870, *41872, *41874, *42200, *42210, *42215, *42220 and *42225 |
| Orthognathic surgery | Adult and pediatric | *21085, *21120, *21121, *21122, *21123, *21125, *21127, *21141, *21142, *21143, *21144, *21145, *21146, *21147, *21150, *21151, *21154, *21155, *21159, *21160, *21188, *21193, *21194, *21195, *21196, *21198, *21199, *21206, *21208, *21209, *21210, *21215, *21230, *21235, *21244, *21245, *21246, *21247, *21255, *21270, *21295 and *21296 |
| Prostatic urethral lift | Adult | *52441 and *52442 |
| Spine surgery, minimally invasive | Adult | G0276 |
| Temporomandibular joint surgery | Adult and pediatric | *20605, *20606, *21010, *21050, *21060, *21070, *21240, *21242, *21243, *21490 and *29804 |
Preview questionnaires will be available online
We'll make preview questionnaires available on this website before June 23. To find them, click BCN, then click Authorization Requirements & Criteria. Next, look in the "Authorization criteria and preview questionnaires" section.
The preview questionnaires will show what questions you'll need to answer in the actual questionnaire that opens in the e-referral system for each service. Once you know what questions you'll need to answer, you can prepare your answers ahead of time. This can cut down on the time it takes to submit the authorization request.
Medical policies will be available online
We'll also post links to the medical policies related to these procedures on the Authorization Requirements & Criteria page.
We use our medical policies and your answers to the questionnaires when making utilization management determinations for the authorization requests you submit.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.