Update: New and updated questionnaires available in the e-referral system on Nov. 22
We use our authorization criteria, our medical policies and your answers to the questionnaires in the e-referral system when making utilization management determinations on your authorization requests.
Starting Nov. 22, 2020, new and updated questionnaires will open in the e-referral system for certain procedures. In addition, the new and updated preview questionnaires, which show the questions you'll need to answer in the actual questionnaires, will be available on the ereferrals.bcbsm.com website by the end of November.
New questionnaire
A new Ventricular assist devices questionnaire will open in the e-referral system for adult BCN AdvantageSM members for these procedure codes: *33990 and *33991.
Updates to existing questionnaires
We're updating and renaming the Mastectomy for male gynecomastia questionnaire for Blue Care Network commercial and BCN Advantage members. The new name for the questionnaire is Surgical treatment for male gynecomastia.
We're also updating the Artificial heart, total questionnaire.
- This questionnaire will open only for BCN commercial members. You'll no longer need to complete this questionnaire for BCN Advantage members.
- You'll need to complete this questionnaire for these procedure codes: *0051T, *0052T, *0053T, *33927, *33928, *33929, *33975, *33976, *33979, *33981, *33982, *33983, *33990, *33991.
- You'll no longer need to complete this questionnaire for these procedure codes: *33992, *33993.
Preview questionnaires
You can access preview questionnaires on this website. This can help you prepare your answers ahead of time.
To find the preview questionnaires, click BCN and then click Authorization Requirements & Criteria. Scroll down and look under the "Authorization criteria and preview questionnaires" heading.
Authorization criteria and medical policies
The pertinent authorization criteria and medical policies are also available on the Authorization Requirements & Criteria page.
*CPT codes, descriptions and two-digit modifiers only are copyright 2019 American Medical Association. All rights reserved.
Posted: November 2020
Line of business: Blue Care Network