TAVI/TAVR procedures for BCN members require plan notification, not authorization

Effective immediately, authorization and clinical review are not required for transcatheter aortic valve implantation and transcatheter aortic valve replacement for BCN HMOSM (commercial) and BCN AdvantageSM members. As a result, you no longer need to submit clinical documentation for these requests.

However, TAVI/TAVR procedures require plan notification to facilitate claims payment. When you submit the plan notification, the request will pend. If the request is for the member to see a contracted provider, we will update the pended request to approved. We are in the process of updating the e-referral system so that these requests will automatically approve in the future.

Refer to the e-referral User Guide for instructions on how to submit a plan notification.

This applies to the following procedures codes, which are for TAVI/TAVR: *33361, *33362, *33363, *33364, *33365, *33366, *33367, *33368 and *33369.

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

Posted: August 2019
Line of business: Blue Care Network