Endometrial ablation and excisional breast biopsy procedures for BCN members require plan notification, not authorization

Effective immediately, authorization and clinical review are not required for endometrial ablation and excisional breast biopsy procedures for BCN HMO^SM (commercial) and BCN Advantage^SM members.

As a result, you no longer need to submit clinical documentation for these requests.

However, these procedures require plan notification to facilitate claims payment. Refer to the e-referral User Guide for instructions on how to submit a plan notification.

This applies to the following procedure codes:

• Endometrial ablation: *58353, *58356 and *58563
• Excisional breast biopsy: *19101, *19120, *19125 and *19126

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.