Utilizing the eviCore Healthcare Web Portal is the most efficient way to initaite a case, check status, review guidelines, view authroziation/eigibility and more. URL: https://www.evicore.com/healthplan/bcbsnm Or call toll-free at 855-252-1117 between 8 a.m. and 8 p.m. (local time) Monday through Friday except holidays. The following outpatient care categories may require preauthorization for Commercial - ASO members with the Wellbeing Management or Health Advocacy Solutions option: Molecular and Genomic Tests (eviCore) Radiation Therapy (eviCore) Advanced Imaging (eviCore) Musculoskeletal - Pain Management (eviCore) Musculoskeletal - Joint and Spine Surgery (eviCore) Ear, Nose and Throat (ENT) Gastroenterology Musculoskeletal Neurology Outpatient Surgery - Orthognathic Surgery (face reconstruction) Outpatient Surgery - Mastopexy (breast lift) Outpatient Surgery - Reduction Mammaplasty (breast reduction) Sleep Studies (eviCore) Specialty Pharmacy Wound Care Dialysis (Prenotification Only) (HAS Only) Maternity (Prenotification Only) (HAS Only) ALL Services listed in Section 10.2 of the Provider Reference Manual, including ALL inpatient services Select Outpatient Procedures (see code list below) This list is not exhaustive. The presence of codes on this list does not necessarily indicate coverage under the member benefits contract. Member contracts differ in their benefits. Consult the member benefit booklet, or contact a customer service representative to determine coverage for a specific medical service or supply. The following care categories require preauthorization through eviCore for all Commercial members: Molecular and Genomic Tests Radiation Therapy Advanced Imaging Musculoskeletal - Pain Management Musculoskeletal - Joint and Spine Surgery Sleep Studies (ASO and FI with HAS/WBM only) The following outpatient care categories may require preauthorization for Commercial - Fully Insured members: Molecular and Genomic Tests (eviCore) Radiation Therapy (eviCore) Advanced Imaging (eviCore) Musculoskeletal - Pain Management (eviCore) Musculoskeletal - Joint and Spine Surgery (eviCore) Ear, Nose and Throat (ENT) Gastroenterology Musculoskeletal Neurology Outpatient Surgery - Orthognathic Surgery (face reconstruction) Outpatient Surgery - Mastopexy (breast lift) Outpatient Surgery - Reduction Mammaplasty (breast reduction) Sleep Studies Wound Care ALL Services listed in Section 10.2 of the Provider Reference Manual, including ALL inpatient services Select Outpatient Procedures (see code list below) Blue Cross Blue Shield of New Mexico Page 1 Additional Outpatient CPT Codes Requiring Preauthorization for Commercial Products Effective 01/01/2020 Procedure Code Service/Category Managed By 2020 Updates 15824 Select Outpatient Services BCBSNM 15826 Select Outpatient Services BCBSNM 19316 Select Outpatient Services BCBSNM 19318 Select Outpatient Services BCBSNM 20930 Joint, Spine Surgery eviCore 20931 Joint, Spine Surgery eviCore 20936 Joint, Spine Surgery eviCore 20937 Joint, Spine Surgery eviCore 20938 Joint, Spine Surgery eviCore 20974 Joint, Spine Surgery eviCore 20975 Joint, Spine Surgery eviCore 21085 Select Outpatient Services BCBSNM 21110 Select Outpatient Services BCBSNM 21125 Select Outpatient Services BCBSNM 21127 Select Outpatient Services BCBSNM 21141 Select Outpatient Services BCBSNM 21142 Select Outpatient Services BCBSNM 21143 Select Outpatient Services BCBSNM 21145 Select Outpatient Services BCBSNM 21146 Select Outpatient Services BCBSNM 21147 Select Outpatient Services BCBSNM 21150 Select Outpatient Services BCBSNM The following list of outpatient procedure codes may require preauthorization for commercial members. This list is not exhaustive. The presence of codes on this list does not necessarily indicate coverage under the member benefits contract. Member contracts differ in their benefits. Consult the member benefit booklet, or contact a customer service representative to determine coverage for a specific medical service or supply. 21151 Select Outpatient Services BCBSNM June 2020
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Embed
Additional Outpatient CPT Codes Requiring …Musculoskeletal - Pain Management Musculoskeletal - Joint and Spine Surgery Sleep Studies (ASO and FI with HAS/WBM only) The following
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Transcript
Utilizing the eviCore Healthcare Web Portal is the most efficient way to initaite a case,
check status, review guidelines, view authroziation/eigibility and more.
URL: https://www.evicore.com/healthplan/bcbsnm
Or call toll-free at 855-252-1117 between 8 a.m. and 8 p.m. (local time)
Monday through Friday except holidays.
The following outpatient care categories may require preauthorization for Commercial -
ASO members with the Wellbeing Management or Health Advocacy Solutions option:
Molecular and Genomic Tests (eviCore)
Radiation Therapy (eviCore)
Advanced Imaging (eviCore)
Musculoskeletal - Pain Management (eviCore)
Musculoskeletal - Joint and Spine Surgery (eviCore)
Ear, Nose and Throat (ENT)
Gastroenterology
Musculoskeletal
Neurology
Outpatient Surgery - Orthognathic Surgery (face reconstruction)
Outpatient Surgery - Mastopexy (breast lift)
Outpatient Surgery - Reduction Mammaplasty (breast reduction)
Sleep Studies (eviCore)
Specialty Pharmacy
Wound Care
Dialysis (Prenotification Only) (HAS Only)
Maternity (Prenotification Only) (HAS Only)
ALL Services listed in Section 10.2 of the Provider Reference Manual,
including ALL inpatient services
Select Outpatient Procedures (see code list below)
This list is not exhaustive. The presence of codes on this list does not necessarily indicate coverage under the member benefits contract. Member contracts differ in their benefits.
Consult the member benefit booklet, or contact a customer service representative to determine coverage for a specific medical service or supply.
The following care categories require preauthorization through
eviCore for all Commercial members:
Molecular and Genomic Tests
Radiation Therapy
Advanced Imaging
Musculoskeletal - Pain Management
Musculoskeletal - Joint and Spine Surgery
Sleep Studies (ASO and FI with HAS/WBM only)
The following outpatient care categories may require preauthorization for Commercial -
Fully Insured members:
Molecular and Genomic Tests (eviCore)
Radiation Therapy (eviCore)
Advanced Imaging (eviCore)
Musculoskeletal - Pain Management (eviCore)
Musculoskeletal - Joint and Spine Surgery (eviCore)
Ear, Nose and Throat (ENT)
Gastroenterology
Musculoskeletal
Neurology
Outpatient Surgery - Orthognathic Surgery (face reconstruction)
Outpatient Surgery - Mastopexy (breast lift)
Outpatient Surgery - Reduction Mammaplasty (breast reduction)
Sleep Studies
Wound Care
ALL Services listed in Section 10.2 of the Provider Reference Manual, including ALL
inpatient services
Select Outpatient Procedures (see code list below)
Blue Cross Blue Shield of New Mexico Page 1
Additional Outpatient CPT Codes
Requiring Preauthorization
for Commercial Products
Effective 01/01/2020
Procedure Code Service/Category Managed By 2020 Updates
The following list of outpatient procedure codes may require preauthorization for commercial members. This list is not exhaustive. The presence of codes
on this list does not necessarily indicate coverage under the member benefits contract. Member contracts differ in their benefits. Consult the member benefit
booklet, or contact a customer service representative to determine coverage for a specific medical service or supply.
21151 Select Outpatient Services BCBSNM
June 2020
21154 Select Outpatient Services BCBSNM21155 Select Outpatient Services BCBSNM21159 Select Outpatient Services BCBSNM21160 Select Outpatient Services BCBSNM21188 Select Outpatient Services BCBSNM21193 Select Outpatient Services BCBSNM21194 Select Outpatient Services BCBSNM21195 Select Outpatient Services BCBSNM21196 Select Outpatient Services BCBSNM21198 Select Outpatient Services BCBSNM21199 Select Outpatient Services BCBSNM21206 Select Outpatient Services BCBSNM21208 Select Outpatient Services BCBSNM21209 Select Outpatient Services BCBSNM21210 Select Outpatient Services BCBSNM21215 Select Outpatient Services BCBSNM21230 Select Outpatient Services BCBSNM22510 Joint, Spine Surgery eviCore22511 Joint, Spine Surgery eviCore22512 Joint, Spine Surgery eviCore22513 Joint, Spine Surgery eviCore22514 Joint, Spine Surgery eviCore22515 Joint, Spine Surgery eviCore22526 Pain Management eviCore22527 Pain Management eviCore22533 Joint, Spine Surgery eviCore22534 Joint, Spine Surgery eviCore22551 Joint, Spine Surgery eviCore22552 Joint, Spine Surgery eviCore22554 Joint, Spine Surgery eviCore22558 Joint, Spine Surgery eviCore22585 Joint, Spine Surgery eviCore22595 Joint, Spine Surgery eviCore Added April 202022600 Joint, Spine Surgery eviCore22612 Joint, Spine Surgery eviCore22614 Joint, Spine Surgery eviCore22630 Joint, Spine Surgery eviCore22632 Joint, Spine Surgery eviCore22633 Joint, Spine Surgery eviCore22634 Joint, Spine Surgery eviCore22840 Joint, Spine Surgery eviCore Add effective Sept 202022841 Joint, Spine Surgery eviCore22842 Joint, Spine Surgery eviCore22843 Joint, Spine Surgery eviCore22844 Joint, Spine Surgery eviCore
Blue Cross Blue Shield of New Mexico
22845 Joint, Spine Surgery eviCore22846 Joint, Spine Surgery eviCore22847 Joint, Spine Surgery eviCore22848 Joint, Spine Surgery eviCore22853 Joint, Spine Surgery eviCore22854 Joint, Spine Surgery eviCore22856 Joint, Spine Surgery eviCore22857 Joint, Spine Surgery eviCore22858 Joint, Spine Surgery eviCore22859 Joint, Spine Surgery eviCore22861 Joint, Spine Surgery eviCore22862 Joint, Spine Surgery eviCore22867 Joint, Spine Surgery eviCore22868 Joint, Spine Surgery eviCore22869 Joint, Spine Surgery eviCore22870 Joint, Spine Surgery eviCore23000 Joint, Spine Surgery eviCore23020 Joint, Spine Surgery eviCore23120 Joint, Spine Surgery eviCore23130 Joint, Spine Surgery eviCore23410 Joint, Spine Surgery eviCore23412 Joint, Spine Surgery eviCore23415 Joint, Spine Surgery eviCore23420 Joint, Spine Surgery eviCore23430 Joint, Spine Surgery eviCore23440 Joint, Spine Surgery eviCore23450 Joint, Spine Surgery eviCore23455 Joint, Spine Surgery eviCore23460 Joint, Spine Surgery eviCore23462 Joint, Spine Surgery eviCore23465 Joint, Spine Surgery eviCore23466 Joint, Spine Surgery eviCore23470 Joint, Spine Surgery eviCore23472 Joint, Spine Surgery eviCore23473 Joint, Spine Surgery eviCore23474 Joint, Spine Surgery eviCore
Procedure Code Service/Category Managed By 2020 Updates
Page 2June 2020
22845 Joint, Spine Surgery eviCore22846 Joint, Spine Surgery eviCore22847 Joint, Spine Surgery eviCore22848 Joint, Spine Surgery eviCore22853 Joint, Spine Surgery eviCore22854 Joint, Spine Surgery eviCore22856 Joint, Spine Surgery eviCore22857 Joint, Spine Surgery eviCore22858 Joint, Spine Surgery eviCore22859 Joint, Spine Surgery eviCore22861 Joint, Spine Surgery eviCore22862 Joint, Spine Surgery eviCore22867 Joint, Spine Surgery eviCore22868 Joint, Spine Surgery eviCore22869 Joint, Spine Surgery eviCore22870 Joint, Spine Surgery eviCore23000 Joint, Spine Surgery eviCore23020 Joint, Spine Surgery eviCore23120 Joint, Spine Surgery eviCore23130 Joint, Spine Surgery eviCore23410 Joint, Spine Surgery eviCore23412 Joint, Spine Surgery eviCore23415 Joint, Spine Surgery eviCore23420 Joint, Spine Surgery eviCore23430 Joint, Spine Surgery eviCore23440 Joint, Spine Surgery eviCore23450 Joint, Spine Surgery eviCore23455 Joint, Spine Surgery eviCore23460 Joint, Spine Surgery eviCore23462 Joint, Spine Surgery eviCore23465 Joint, Spine Surgery eviCore23466 Joint, Spine Surgery eviCore23470 Joint, Spine Surgery eviCore23472 Joint, Spine Surgery eviCore23473 Joint, Spine Surgery eviCore23474 Joint, Spine Surgery eviCore27096 Pain Management eviCore27125 Joint, Spine Surgery eviCore27130 Joint, Spine Surgery eviCore27132 Joint, Spine Surgery eviCore27134 Joint, Spine Surgery eviCore27137 Joint, Spine Surgery eviCore27138 Joint, Spine Surgery eviCore27279 Joint, Spine Surgery eviCore Add effective Sept 202027280 Joint, Spine Surgery eviCore Add effective Sept 202027332 Joint, Spine Surgery eviCore27333 Joint, Spine Surgery eviCore27334 Joint, Spine Surgery eviCore27335 Joint, Spine Surgery eviCore27403 Joint, Spine Surgery eviCore27412 Joint, Spine Surgery eviCore27415 Joint, Spine Surgery eviCore27416 Joint, Spine Surgery eviCore27418 Joint, Spine Surgery eviCore27420 Joint, Spine Surgery eviCore27422 Joint, Spine Surgery eviCore27424 Joint, Spine Surgery eviCore27425 Joint, Spine Surgery eviCore27427 Joint, Spine Surgery eviCore27428 Joint, Spine Surgery eviCore27429 Joint, Spine Surgery eviCore27430 Joint, Spine Surgery eviCore27438 Joint, Spine Surgery eviCore27440 Joint, Spine Surgery eviCore27441 Joint, Spine Surgery eviCore27442 Joint, Spine Surgery eviCore27443 Joint, Spine Surgery eviCore27446 Joint, Spine Surgery eviCore27447 Joint, Spine Surgery eviCore27486 Joint, Spine Surgery eviCore27487 Joint, Spine Surgery eviCore30120 Select Outpatient Services BCBSNM30124 Select Outpatient Services BCBSNM30130 Select Outpatient Services BCBSNM30140 Select Outpatient Services BCBSNM30400 Select Outpatient Services BCBSNM30410 Select Outpatient Services BCBSNM30420 Select Outpatient Services BCBSNM
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Procedure Code Service/Category Managed By 2020 Updates
Page 7June 2020
78699 Advanced Imaging eviCore78700 Advanced Imaging eviCore78701 Advanced Imaging eviCore78707 Advanced Imaging eviCore78708 Advanced Imaging eviCore78709 Advanced Imaging eviCore78710 Advanced Imaging eviCore Remove effective Sept 202078725 Advanced Imaging eviCore78730 Advanced Imaging eviCore78740 Advanced Imaging eviCore78761 Advanced Imaging eviCore78800 Advanced Imaging eviCore78801 Advanced Imaging eviCore78802 Advanced Imaging eviCore78803 Advanced Imaging eviCore78804 Advanced Imaging eviCore78805 Advanced Imaging eviCore Remove effective Sept 202078806 Advanced Imaging eviCore Remove effective Sept 202078807 Advanced Imaging eviCore Remove effective Sept 202078811 Advanced Imaging eviCore78812 Advanced Imaging eviCore78813 Advanced Imaging eviCore78814 Advanced Imaging eviCore78815 Advanced Imaging eviCore78816 Advanced Imaging eviCore78830 Advanced Imaging eviCore Added April 202078831 Advanced Imaging eviCore Added April 202078832 Advanced Imaging eviCore Added April 202078999 Advanced Imaging eviCore Add effective Sept 202079005 Radiation Oncology eviCore Added April 202079101 Radiation Oncology eviCore Added April 202079403 Radiation Oncology eviCore Added April 202081162 Molecular and Genetic Lab eviCore81163 Molecular and Genetic Lab eviCore Added April 202081164 Molecular and Genetic Lab eviCore Added April 202081165 Molecular and Genetic Lab eviCore Added April 202081166 Molecular and Genetic Lab eviCore Added April 202081167 Molecular and Genetic Lab eviCore Added April 202081173 Molecular and Genetic Lab eviCore Added April 202081174 Molecular and Genetic Lab eviCore Added April 202081185 Molecular and Genetic Lab eviCore Added April 202081186 Molecular and Genetic Lab eviCore Added April 202081189 Molecular and Genetic Lab eviCore Added April 202081190 Molecular and Genetic Lab eviCore Added April 202081201 Molecular and Genetic Lab eviCore81202 Molecular and Genetic Lab eviCore Added April 202081203 Molecular and Genetic Lab eviCore81212 Molecular and Genetic Lab eviCore81215 Molecular and Genetic Lab eviCore81216 Molecular and Genetic Lab eviCore81217 Molecular and Genetic Lab eviCore81221 Molecular and Genetic Lab eviCore Added April 202081222 Molecular and Genetic Lab eviCore81223 Molecular and Genetic Lab eviCore81225 Molecular and Genetic Lab eviCore81226 Molecular and Genetic Lab eviCore81227 Molecular and Genetic Lab eviCore81228 Molecular and Genetic Lab eviCore81229 Molecular and Genetic Lab eviCore81230 Molecular and Genetic Lab eviCore Added April 202081231 Molecular and Genetic Lab eviCore Added April 202081232 Molecular and Genetic Lab eviCore Added April 202081238 Molecular and Genetic Lab eviCore Added April 202081248 Molecular and Genetic Lab eviCore Added April 202081249 Molecular and Genetic Lab eviCore Added April 202081252 Molecular and Genetic Lab eviCore Added April 202081253 Molecular and Genetic Lab eviCore Added April 202081257 Molecular and Genetic Lab eviCore Added April 202081258 Molecular and Genetic Lab eviCore Added April 202081259 Molecular and Genetic Lab eviCore Added April 202081269 Molecular and Genetic Lab eviCore Added April 202081277 Molecular and Genetic Lab eviCore Added April 202081283 Molecular and Genetic Lab eviCore Added April 202081286 Molecular and Genetic Lab eviCore Added April 202081289 Molecular and Genetic Lab eviCore Added April 202081291 Molecular and Genetic Lab eviCore81292 Molecular and Genetic Lab eviCore81293 Molecular and Genetic Lab eviCore Added April 202081294 Molecular and Genetic Lab eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 8June 2020
81295 Molecular and Genetic Lab eviCore81296 Molecular and Genetic Lab eviCore Added April 202081297 Molecular and Genetic Lab eviCore81298 Molecular and Genetic Lab eviCore81299 Molecular and Genetic Lab eviCore Added April 202081300 Molecular and Genetic Lab eviCore81302 Molecular and Genetic Lab eviCore Added April 202081303 Molecular and Genetic Lab eviCore Added April 202081304 Molecular and Genetic Lab eviCore Added April 202081306 Molecular and Genetic Lab eviCore Added April 202081307 Molecular and Genetic Lab eviCore Added April 202081308 Molecular and Genetic Lab eviCore Added April 202081313 Molecular and Genetic Lab eviCore81317 Molecular and Genetic Lab eviCore81318 Molecular and Genetic Lab eviCore Added April 202081319 Molecular and Genetic Lab eviCore81321 Molecular and Genetic Lab eviCore81322 Molecular and Genetic Lab eviCore Added April 202081323 Molecular and Genetic Lab eviCore81325 Molecular and Genetic Lab eviCore81326 Molecular and Genetic Lab eviCore Added April 202081327 Molecular and Genetic Lab eviCore81328 Molecular and Genetic Lab eviCore Added April 202081335 Molecular and Genetic Lab eviCore Added April 202081336 Molecular and Genetic Lab eviCore Added April 202081337 Molecular and Genetic Lab eviCore Added April 202081346 Molecular and Genetic Lab eviCore Added April 202081350 Molecular and Genetic Lab eviCore Added April 202081355 Molecular and Genetic Lab eviCore81361 Molecular and Genetic Lab eviCore Added April 202081362 Molecular and Genetic Lab eviCore Added April 202081363 Molecular and Genetic Lab eviCore Added April 202081364 Molecular and Genetic Lab eviCore Added April 202081400 Molecular and Genetic Lab eviCore81401 Molecular and Genetic Lab eviCore81402 Molecular and Genetic Lab eviCore81403 Molecular and Genetic Lab eviCore81404 Molecular and Genetic Lab eviCore81405 Molecular and Genetic Lab eviCore81406 Molecular and Genetic Lab eviCore81407 Molecular and Genetic Lab eviCore81408 Molecular and Genetic Lab eviCore81410 Molecular and Genetic Lab eviCore81411 Molecular and Genetic Lab eviCore81412 Molecular and Genetic Lab eviCore81413 Molecular and Genetic Lab eviCore81414 Molecular and Genetic Lab eviCore81415 Molecular and Genetic Lab eviCore81416 Molecular and Genetic Lab eviCore81417 Molecular and Genetic Lab eviCore81420 Molecular and Genetic Lab eviCore Remove effective Sept 202081422 Molecular and Genetic Lab eviCore81425 Molecular and Genetic Lab eviCore81426 Molecular and Genetic Lab eviCore81427 Molecular and Genetic Lab eviCore81430 Molecular and Genetic Lab eviCore81431 Molecular and Genetic Lab eviCore81432 Molecular and Genetic Lab eviCore81433 Molecular and Genetic Lab eviCore81434 Molecular and Genetic Lab eviCore81435 Molecular and Genetic Lab eviCore81436 Molecular and Genetic Lab eviCore81437 Molecular and Genetic Lab eviCore81438 Molecular and Genetic Lab eviCore81439 Molecular and Genetic Lab eviCore81440 Molecular and Genetic Lab eviCore81442 Molecular and Genetic Lab eviCore81443 Molecular and Genetic Lab eviCore Added April 202081445 Molecular and Genetic Lab eviCore81448 Molecular and Genetic Lab eviCore Added April 202081450 Molecular and Genetic Lab eviCore81455 Molecular and Genetic Lab eviCore81460 Molecular and Genetic Lab eviCore81465 Molecular and Genetic Lab eviCore81470 Molecular and Genetic Lab eviCore81471 Molecular and Genetic Lab eviCore81479 Molecular and Genetic Lab eviCore81490 Molecular and Genetic Lab eviCore81493 Molecular and Genetic Lab eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 9June 2020
81500 Molecular and Genetic Lab eviCore Added April 202081503 Molecular and Genetic Lab eviCore Added April 202081504 Molecular and Genetic Lab eviCore81507 Molecular and Genetic Lab eviCore Remove effective Sept 202081518 Molecular and Genetic Lab eviCore Added April 202081519 Molecular and Genetic Lab eviCore81520 Molecular and Genetic Lab eviCore Added April 202081521 Molecular and Genetic Lab eviCore Added April 202081522 Molecular and Genetic Lab eviCore Added April 202081525 Molecular and Genetic Lab eviCore81528 Molecular and Genetic Lab eviCore Remove effective Sept 202081535 Molecular and Genetic Lab eviCore81536 Molecular and Genetic Lab eviCore81538 Molecular and Genetic Lab eviCore81539 Molecular and Genetic Lab eviCore81540 Molecular and Genetic Lab eviCore81541 Molecular and Genetic Lab eviCore Added April 202081542 Molecular and Genetic Lab eviCore Added April 202081545 Molecular and Genetic Lab eviCore81551 Molecular and Genetic Lab eviCore Added April 202081552 Molecular and Genetic Lab eviCore Added April 202081595 Molecular and Genetic Lab eviCore81596 Molecular and Genetic Lab eviCore Added April 202081599 Molecular and Genetic Lab eviCore84999 Molecular and Genetic Lab eviCore92633 Select Outpatient Services eviCore Remove effective Sept 202095782 Sleep Medicine eviCore95783 Sleep Medicine eviCore95800 Sleep Medicine eviCore95801 Sleep Medicine eviCore95805 Sleep Medicine eviCore95806 Sleep Medicine eviCore95807 Sleep Medicine eviCore95807 Sleep Medicine eviCore95808 Sleep Medicine eviCore95808 Sleep Medicine eviCore95810 Sleep Medicine eviCore95810 Sleep Medicine eviCore95811 Sleep Medicine eviCore95811 Sleep Medicine eviCore95980 Select Outpatient Services BCBSNM99183 Select Outpatient Services BCBSNM
0001U Molecular and Genetic Lab eviCore Added April 20200002M Molecular and Genetic Lab eviCore Added April 20200003M Molecular and Genetic Lab eviCore Added April 20200004M Molecular and Genetic Lab eviCore0005U Molecular and Genetic Lab eviCore Added April 20200006M Molecular and Genetic Lab eviCore0007M Molecular and Genetic Lab eviCore0009M Molecular and Genetic Lab eviCore Remove effective Sept 20200011M Molecular and Genetic Lab eviCore Added April 20200012M Molecular and Genetic Lab eviCore Added April 20200012U Molecular and Genetic Lab eviCore Added April 20200013M Molecular and Genetic Lab eviCore Added April 20200013U Molecular and Genetic Lab eviCore Added April 20200014U Molecular and Genetic Lab eviCore Added April 20200018U Molecular and Genetic Lab eviCore Added April 20200019U Molecular and Genetic Lab eviCore Added April 20200022U Molecular and Genetic Lab eviCore Added April 20200026U Molecular and Genetic Lab eviCore Added April 20200029U Molecular and Genetic Lab eviCore Added April 20200030U Molecular and Genetic Lab eviCore Added April 20200031U Molecular and Genetic Lab eviCore Added April 20200032U Molecular and Genetic Lab eviCore Added April 20200033U Molecular and Genetic Lab eviCore Added April 20200034U Molecular and Genetic Lab eviCore Added April 20200036U Molecular and Genetic Lab eviCore Added April 2020
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 10June 2020
0037U Molecular and Genetic Lab eviCore Added April 20200042T Advanced Imaging eviCore0045U Molecular and Genetic Lab eviCore Added April 20200047U Molecular and Genetic Lab eviCore Added April 20200048U Molecular and Genetic Lab eviCore Added April 20200050U Molecular and Genetic Lab eviCore Added April 20200053U Molecular and Genetic Lab eviCore Added April 20200055U Molecular and Genetic Lab eviCore Added April 20200056U Molecular and Genetic Lab eviCore Added April 20200060U Molecular and Genetic Lab eviCore Added April 20200067U Molecular and Genetic Lab eviCore Added April 20200069U Molecular and Genetic Lab eviCore Added April 2020
0070U Molecular and Genetic Lab eviCore Added April 20200071U Molecular and Genetic Lab eviCore Added April 20200072U Molecular and Genetic Lab eviCore Added April 20200073U Molecular and Genetic Lab eviCore Added April 20200074U Molecular and Genetic Lab eviCore Added April 20200075U Molecular and Genetic Lab eviCore Added April 20200076U Molecular and Genetic Lab eviCore Added April 20200078U Molecular and Genetic Lab eviCore Added April 20200079U Molecular and Genetic Lab eviCore Added April 20200084U Molecular and Genetic Lab eviCore Added April 20200087U Molecular and Genetic Lab eviCore Added April 20200088U Molecular and Genetic Lab eviCore Added April 20200089U Molecular and Genetic Lab eviCore Added April 20200090U Molecular and Genetic Lab eviCore Added April 20200094U Molecular and Genetic Lab eviCore Added April 20200095T Joint, Spine Surgery eviCore0098T Joint, Spine Surgery eviCore0101U Molecular and Genetic Lab eviCore Added April 20200102U Molecular and Genetic Lab eviCore Added April 20200103U Molecular and Genetic Lab eviCore Added April 20200104U Molecular and Genetic Lab eviCore Added April 20200111U Molecular and Genetic Lab eviCore Added April 20200113U Molecular and Genetic Lab eviCore Added April 20200114U Molecular and Genetic Lab eviCore Added April 20200118U Molecular and Genetic Lab eviCore Added April 20200120U Molecular and Genetic Lab eviCore Added April 20200129U Molecular and Genetic Lab eviCore Added April 20200130U Molecular and Genetic Lab eviCore Added April 20200131U Molecular and Genetic Lab eviCore Added April 20200132U Molecular and Genetic Lab eviCore Added April 20200133U Molecular and Genetic Lab eviCore Added April 20200134U Molecular and Genetic Lab eviCore Added April 20200135U Molecular and Genetic Lab eviCore Added April 20200136U Molecular and Genetic Lab eviCore Added April 20200137U Molecular and Genetic Lab eviCore Added April 20200138U Molecular and Genetic Lab eviCore Added April 20200153U Molecular and Genetic Lab eviCore Added April 20200156U Molecular and Genetic Lab eviCore Added April 20200157U Molecular and Genetic Lab eviCore Added April 20200158U Molecular and Genetic Lab eviCore Added April 20200159U Molecular and Genetic Lab eviCore Added April 20200160U Molecular and Genetic Lab eviCore Added April 20200161U Molecular and Genetic Lab eviCore Added April 20200162U Molecular and Genetic Lab eviCore Added April 20200163T Joint, Spine Surgery eviCore0164T Joint, Spine Surgery eviCore0165T Joint, Spine Surgery eviCore0169U Molecular and Genetic Lab eviCore Added April 20200170U Molecular and Genetic Lab eviCore Added April 20200171U Molecular and Genetic Lab eviCore Added April 20200172U Molecular and Genetic Lab eviCore Add effective Sept 20200173U Molecular and Genetic Lab eviCore Add effective Sept 20200175U Molecular and Genetic Lab eviCore Add effective Sept 20200179U Molecular and Genetic Lab eviCore Add effective Sept 20200213T Pain Management eviCore Added April 20200214T Pain Management eviCore Added April 20200215T Pain Management eviCore Added April 20200216T Pain Management eviCore Added April 20200217T Pain Management eviCore Added April 20200218T Pain Management eviCore Added April 20200228T Pain Management eviCore0229T Pain Management eviCore0230T Pain Management eviCore0231T Pain Management eviCore0274T Pain Management eviCore0275T Pain Management eviCore0312T Select Outpatient Services BCBSNM
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates