Starting March 28, new and updated questionnaires in the e-referral system

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 March 28, 2021, we added and updated questionnaires in the e-referral system. We also added and updated corresponding preview questionnaires on the ereferrals.bcbsm.com website.

New questionnaires

We added the following questionnaires:

• Gastric pacing / stimulation - This questionnaire now opens for BCN commercial members for procedure codes *43647, *43648, *43881, *43882, *64590 and *64595.

  Note: This questionnaire already opened for BCN Advantage^SM and Medicare Plus Blue^SM members.

• We replaced the Chemical peels questionnaire with the following two questionnaires for pediatric and adult BCN commercial and BCN Advantage members:
  • Dermal chemical peel - This questionnaire opens for procedure codes *15789 and *15793.
  • Epidermal chemical peel - This questionnaire opens for procedure codes *15788, *15792 and *17360.

Updated questionnaires

We updated the following questionnaires for BCN commercial and BCN Advantage members:

• Bone-anchored hearing aid
• Sleep studies

Preview questionnaires

You can access preview questionnaires on this website. They show the questions you'll need to answer in the actual questionnaires that open in the e-referral system. 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 pages.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2020 American Medical Association. All rights reserved.

Posted: March 2021
Line of business: Blue Care Network