eviCore healthcare to review additional outpatient pain management services for BCN effective Dec. 1

For dates of service on or after Dec. 1, 2016, authorization is required through eviCore healthcare for additional outpatient pain management services for adult and pediatric Blue Care Network HMO^SM (commercial) and BCN Advantage^SM members, for all diagnoses. Currently, eviCore reviews epidural and facet joint injections for BCN.

The codes for the additional services that eviCore will review are: *0213T, *0214T, *0215T, *0216T, *0217T, *0218T, *0228T, *0229T, *0230T, *0231T, *27096, *62263, *62264, *62280, *64470, *64472, *64475, *64476, *64510, *64520, *64620, *64626, *64627, *64633, *64634, *64635 and *64636. These services include sacroiliac joint injections, epidural adhesiolysis, radiofrequency ablation and regional sympathetic blocks.

The list of procedures that require review by eviCore healthcare is being updated to reflect these additional codes.

Authorization from eviCore is required for these outpatient pain management services. Services performed without authorization may be denied for payment.

Look for additional information on this topic in the November-December 2016 issue of BCN Provider News, which will be available online in late October.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2015 American Medical Association. All rights reserved.

Posted: September 2016
Line of business: Blue Care Network