Authorization Requirements & Criteria

Important information during the coronavirus (COVID-19) pandemic

For temporary changes and recommendations for providers, refer to our COVID-19 provider webpage

Find more information for providers:

  1. Log in as a provider at bcbsm.com/providers.
  2. Click Coronavirus (COVID-19).

This page provides Blue Cross Blue Shield of Michigan's authorization requirements, including information that applies to:

For Blue Cross commercial members

Information on requesting authorization – Blue Cross commercial

Utilization management criteria – Blue Cross commercial

Forms – Blue Cross commercial

Air ambulance authorization requests – Blue Cross commercial

Blue Cross PPO (commercial) Provider Manual

To access the manual, complete these steps:

  1. Visit bcbsm.com/providers
  2. Log in to Provider Secured Services.
  3. Click Provider Manuals.
  4. Click Blue Cross PPO Provider Manual.

For Medicare Plus Blue members

Services that require authorization – Medicare Plus Blue

Utilization management criteria – Medicare Plus Blue

Forms – Medicare Plus Blue

Authorization criteria and preview questionnaires – Medicare Plus Blue

Various procedures
Deep brain stimulation Refer to the medical policy on Deep Brain Stimulation (PDF)
Preview questionnaire (PDF)
Endovascular intervention, peripheral artery Authorization criteria (PDF)
Preview questionnaire (PDF)
Ethmoidectomy, endoscopic Authorization criteria (PDF)
Preview questionnaire (PDF)
Gastric pacing / stimulation Refer to the medical policy on Gastric Electrical Stimulation (PDF)
Preview questionnaire (PDF)
Hammertoe correction surgery Authorization criteria (PDF)
Preview questionnaire (PDF)
Noncoronary vascular stents Authorization criteria (PDF)
Preview questionnaire (PDF)
Sacral nerve neuromodulation/stimulation Refer to the medical policy on Sacral Nerve Neuromodulation / Stimulation (PDF)
Preview questionnaire (PDF)
Sinusotomy, frontal, endoscopic Authorization criteria (PDF)
Preview questionnaire (PDF)
Vascular embolization or occlusion of hepatic tumors (TACE/RFA) Refer to the medical policy on:
  • Transcatheter Arterial Chemoembolization of Hepatic Tumors (TACE) (PDF)
  • Radioembolization for Primary and Metastatic Tumors of the Liver (PDF)
  • Preview questionnaire (PDF)

    The following documents pertain to procedures for which the Medicare Plus Blue Utilization Management department manages authorizations for dates of service prior to Jan. 1, 2021.

    For dates of service on or after Jan. 1, 2021, TurningPoint Healthcare Solutions LLC manages authorization requests. See the Musculoskeletal Services page for more information about TurningPoint.

    Certain Musculoskeletal Procedures, for dates of service prior to Jan. 1, 2021
    Epidural or intrathecal catheter (trial or permanent placement) Authorization criteria (PDF)
    Preview questionnaire (PDF)
    Spinal cord stimulator Authorization criteria (PDF)
    Preview questionnaire (PDF)