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MT Comm Prod Code Look Up 2023

Medical billing and coding

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ramyakrishnanmop
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13 views1 page

MT Comm Prod Code Look Up 2023

Medical billing and coding

Uploaded by

ramyakrishnanmop
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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2023 Commercial Procedure Code Look Up

How to use: Click Search box. Select a 5 digit code using the dropdown arrow to check if code requires preauthorization or if pre-service review is advised. Additional instructions are
C9146 provided below.
Note: This Code Look Up list is not exhaustive. Codes are updated throughout the year. Contact Provider Customer Service for questions on medical necessity review.

If code is not in the list, you may call customer service at the number on your identification card.

Code Description: Elahere (mirvetuximab soravtansine-gynx)

Effective Code Termed 07/01/2023 -


Code Group Description: Prior Authorization may be required per contract agreement. This code is replaced with
Dates/Updates J9063

*To download copies of the 2023 Commercial Prior Authorization or RCR (Predetermination) Code Lists, visit BCBSMT site. https://www.bcbsmt.com/provider/claims-and-eligibility/utilization-management

*Note: List was based from report run last 06/16/2023.

This list includes Current Procedural Terminology (CPT®) and/or Healthcare Common Procedure Coding System (HCPCS) codes related to services/categories for which Medical Necessity Review applies for Blue Cross and Blue Shield of Montana.
This is not an exhaustive listing of all codes. Codes may change, and this list may be updated throughout the year. 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.
To make a request for a predetermination review, contact Blue Cross and Blue Shield customer service at the number on your identification card.

How to use this document:


- Follow these steps to check if a procedure code requires preauthorization (PA) or if pre-service review is advised (info provide in Code Group Description section):
1) Bring cursor to highlighted Search box above. Click to select box. Delete existing values, if any.
2) Once Search box has been selected, the dropdown arrow will appear on the lower right corner of the box.
3) Click on the dropdown arrow to display codes that can be selected.
4) Select the code of interest . Codes are sorted from small to largest value.
5) Click on a code to display the related info on sections Code Description (CPT/HCPCS description) and Code Group Description (e.g. requires PA, etc.)

Note:
- Code may appear twice if it exists in multiple Code Group. Same information will be displayed no matter what you choose.
- As an alternative to using the dropdown arrow, type in and enter the code of interest in the Search box.
This message will appear if code entered is not in the list. "Select code using drop down arrow".
- This list is not exhaustive. Codes are updated throughout year. Contact customer service for any questions.

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