Capital BlueCross: New preauthorization requirement changes for April 2014

New preauthorization requirement changes will take affect for plans on or after April 1, 2014.  The changes affect the following benefits:

High Tech Non-Emergency Imaging Procedures

  • All high tech, non-emergency imaging procedures will require preauthorization including (preauthorization for the above services is not being added for Traditional members):
    • MRI (Magnetic Resonance Imaging)
    • MRA (Magnetic Resonance Angiography)
    • CT (Computerized Tomography) Scans
    • CTA ( Computerized Tomography Angiography) Scans
    • PET (Positron Emission Tomography) Scans
    • SPECT (Single Proton Emission Computerized Tomography) Scans

Observation Care

  • All observation cases will require preauthorization for continued observation status that exceeds or is expected to exceed 48 hours.

Radiofrequency Ablation for Pain Management/Denervation of Facet Joint Pain Management

  • Radiofrequency ablation for pain management (Facet Joint Denervation) will require preauthorization.


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The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.