New and updated e-referral questionnaires to open August 25 for BCN and Medicare Plus BlueSM PPO
Starting Aug. 25, 2019, new and updated questionnaires will open in the e-referral system for certain procedures. In addition, new and updated preview questionnaires, authorization criteria and medical policies will be available on this website.
New questionnaires
Starting August 25, questionnaires will open in the e-referral system for BCN HMOSM and BCN AdvantageSM authorization requests for the procedures listed below, which already require authorization.
| Service | Age | Procedure codes |
|---|---|---|
| Bariatric surgery - BCN HMO | Adult and adolescents | *43644, *43645, *43770, *43771, *43772, *43773, *43774, *43775, *43842, *43843, *43845, *43846, *43847, *43848, *43886, *43887, *43888 and *44130 |
| Bone-anchored hearing aid | Adult and pediatric (5 years old and older) | *69714, *69715, *69717 and *69718 |
| Cardiac rehabilitation - BCN HMO | Adult and pediatric | *93797 and *93798 (for select diagnoses) |
| Cardiac rehabilitation - BCN Advantage | ||
| Pregnancy termination - BCN HMO | Adult | *01966, *59100, *59840, *59841, *59850, *59851, *59852, *59855, *59856, *59857, *59866, *88304, *88305, S0190, S0191, S0199, S2260, S2265, S2266 and S2267 |
| Pregnancy termination - BCN Advantage | ||
| Pulmonary rehabilitation | Adult and pediatric | G0237, G0238, G0239, G0302, G0303, G0304, G0424 and S9473 |
| Radiofrequency ablation, peripheral nerves | Adult | *64640 |
| Visual training, orthotic and pleoptic | Adult and pediatric | *92065 |
Updates to existing questionnaires
In addition, updated questionnaires will open in the e-referral system on August 25 for BCN HMO, BCN Advantage and Medicare Plus Blue authorization requests (unless otherwise noted), for the following services:
- Cervical spine surgery - opens only for BCN HMO and BCN Advantage
- Cholecystectomy (laparoscopic) - opens only for BCN HMO and BCN Advantage
- Endovascular intervention, peripheral artery - The updated questionnaire for this service was originally scheduled to open starting on July 28 for Medicare Plus Blue requests but will actually open starting August 25.
- Ethmoidectomy
- Hammertoe correction surgery
- Hip arthroplasty, total, revision
- Knee arthroplasty, total, revision
- Sacral nerve neuromodulation/stimulation
- Sinusotomy, frontal, endoscopic
- Sleep studies, outpatient facility or clinic-based setting - opens only for BCN HMO and BCN Advantage
- Vascular embolization or occlusion of hepatic tumors (TACE/RFA)
Preview questionnaires
We'll make preview questionnaires available on this website soon. To find them:
- For BCN: Click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading.
- For Medicare Plus Blue: Click Blue Cross and then click Authorization Requirements & Criteria. In the "Medicare Plus Blue PPO members" section, look under the "Authorization criteria and preview questionnaires - Medicare Plus Blue PPO" heading.
The preview questionnaires show the questions you'll need to answer in the actual questionnaires that open in the e-referral system. This will help you prepare your answers ahead of time.
Authorization criteria and medical policies
We'll also post links to the pertinent authorization criteria and medical policies on the Authorization Requirements & Criteria pages.
We use our authorization criteria and medical policies and your answers to the questionnaires when making utilization management determinations on your authorization requests.
*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2018 American Medical Association. All rights reserved.