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UPDATE – Preauthorization Requirements for Select Cardiology Services

Audience: Participating Cardiologists

Excellus BlueCross BlueShield is keeping a close eye on New York state COVID-19 emergency regulations and executive orders, which continue to be extended. We are also sensitive to staffing challenges that many offices and facilities continue to experience as a result of the pandemic. Due to these considerations, we have re-evaluated the implementation of preauthorization requirements for select cardiology services through eviCore healthcare, MSI LLC, d/b/a eviCore healthcare (“eviCore healthcare”), an independent company.

What this means to you. At this time, we will not implement preauthorization requirements for diagnostic heart catheterization services (i.e., CPT codes 93451-93462 and 93530-93533) for Commercial and Medicare lines of business. It’s important to note that we will work with eviCore healthcare to monitor the medical necessity and appropriateness of care for these services.

We will implement preauthorization requirements for echocardiography services (i.e., CPT codes
93303-93308, 93312-93317, C8921-C8926, C8929, 0439T), but have delayed this implementation to dates of services on or after October 1, 2022, to provide additional time for practices to prepare and consider connecting their electronic medical records software with eviCore healthcare’s intelliPath®
real-time preauthorization automation tool to reduce administrative burden and improve efficiencies.
Echocardiography services performed without authorization may not be reimbursed, and the member will not be held responsible for payment.

Please keep in mind that 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 October 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:

Questions about the preauthorization process? We encourage you to attend an online orientation session! The orientation schedule and program training resources are available on the eviCore website.

eviCore’s clinical guidelines and request forms are available on the eviCore website. Please contact your Provider Relations representative or call 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.

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