Return to Provider News

Preauthorization Requirements for Select Cardiology Services Effective August 1, 2022

Audience: Participating Cardiologists

Excellus BlueCross BlueShield is working with eviCore healthcare, MSI LLC d/b/a eviCore healthcare (“eviCore healthcare”), an independent company, to review for medical necessity and appropriateness of care related to echocardiography and diagnostic heart catheterization services. 

For dates of service on or after August 1, 2022, the CPT® codes listed will require preauthorization. Services performed without authorization may not be reimbursed, and the member will not be held responsible for payment.  Preauthorization applies to Commercial, Medicare and Safety Net lines of business. 

Services performed in conjunction with an inpatient stay, 23-hour observation, or emergency room visits are not subject to preauthorization requirements.  Services performed on Excellus BCBS members aged 19 and under are also excluded. As of August 1, initial requests for transthoracic echocardiography will be reviewed with a 24-month look-back period to determine whether it is an initial or repeat procedure.

To initiate a preauthorization request, please use one of the following methods: 

We do not require preauthorization for radiology and cardiac imaging studies when a patient presents in an urgent care/emergency department, 23-observation level of care at the hospital or for inpatient services. 

Preauthorization is required through eviCore healthcare when, in the ordering physician's judgment, the patient's condition is urgent/emergent and the service is provided in an outpatient setting. The reviews will need to be requested and documented as urgent/emergent same-day requests. The preauthorization requests can be made via phone, fax, or web at eviCore.com and will be completed within 3 hours.

Questions about the preauthorization process? Attend an online orientation session! The orientation schedule and program training resources are available at: www.evicore.com/resources/healthplan/excellus-bcbs

eviCore’s clinical guidelines and request forms are available at www.evicore.com. Please call your Provider Relations representative or eviCore’s Client and Provider Services department at 1-800-646-0418 (Option 4) if you have any questions or would like additional information.

Thank you for collaborating with us to ensure that we can continue to provide high-quality, affordable health care to individuals in the communities we mutually serve. 

For dates of service on or after August 1, 2022, the following services will require preauthorization:

ECHOCARDIOGRAPHY 
93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, C8921, C8922, C8923, C8924, C8925, C8926, C8929, 0439T

DIAGNOSTIC HEART CATHERIZATION
93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 
93530, 93531, 93532, 93533

Related News
UPDATE – Preauthorization Requirements for Select Cardiology Services

Preauthorization Updates Effective October 1, 2022, for All Lines of Business Requiring Preauthorization

Preauthorization Updates Effective May 1, 2022 for All Lines of Business Requiring Preauthorization

Drug-Eluting Sinus Stents for Post-operative use following Endoscopic Sinus Surgery Medical Policy Update Effective September 15, 2022

Musculoskeletal Medical Policy Updates Effective September 15, 2022

Category

Excellus

Utilization Management

IE Browser Modal