Additional Outpatient CPT Codes Requiring …Musculoskeletal - Pain Management Musculoskeletal -...
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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
Transcript of Additional Outpatient CPT Codes Requiring …Musculoskeletal - Pain Management Musculoskeletal -...
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 BCBSNM15826 Select Outpatient Services BCBSNM19316 Select Outpatient Services BCBSNM19318 Select Outpatient Services BCBSNM20930 Joint, Spine Surgery eviCore20931 Joint, Spine Surgery eviCore20936 Joint, Spine Surgery eviCore20937 Joint, Spine Surgery eviCore20938 Joint, Spine Surgery eviCore20974 Joint, Spine Surgery eviCore20975 Joint, Spine Surgery eviCore21085 Select Outpatient Services BCBSNM21110 Select Outpatient Services BCBSNM21125 Select Outpatient Services BCBSNM21127 Select Outpatient Services BCBSNM21141 Select Outpatient Services BCBSNM21142 Select Outpatient Services BCBSNM21143 Select Outpatient Services BCBSNM21145 Select Outpatient Services BCBSNM21146 Select Outpatient Services BCBSNM21147 Select Outpatient Services BCBSNM21150 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
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
23474 Joint, Spine Surgery eviCore
Page 3June 2020
30435 Select Outpatient Services BCBSNM30450 Select Outpatient Services BCBSNM30465 Select Outpatient Services BCBSNM30520 Select Outpatient Services BCBSNM30999 Select Outpatient Services BCBSNM31296 Select Outpatient Services BCBSNM31297 Select Outpatient Services BCBSNM31299 Select Outpatient Services BCBSNM36516 Select Outpatient Services BCBSNM38206 Select Outpatient Services BCBSNM38230 Select Outpatient Services BCBSNM38241 Select Outpatient Services BCBSNM43647 Select Outpatient Services BCBSNM43648 Select Outpatient Services BCBSNM43881 Select Outpatient Services BCBSNM61850 Select Outpatient Services BCBSNM61863 Select Outpatient Services BCBSNM61864 Select Outpatient Services BCBSNM61867 Select Outpatient Services BCBSNM61868 Select Outpatient Services BCBSNM62263 Pain Management eviCore62264 Pain Management eviCore62280 Pain Management eviCore62281 Pain Management eviCore62282 Pain Management eviCore62287 Pain Management eviCore62292 Pain Management eviCore62320 Pain Management eviCore62321 Pain Management eviCore62322 Pain Management eviCore62323 Pain Management eviCore62324 Pain Management eviCore62325 Pain Management eviCore62326 Pain Management eviCore62327 Pain Management eviCore62350 Pain Management eviCore62351 Pain Management eviCore62360 Pain Management eviCore62361 Pain Management eviCore62362 Pain Management eviCore62380 Joint, Spine Surgery eviCore63001 Joint, Spine Surgery eviCore63005 Joint, Spine Surgery eviCore63012 Joint, Spine Surgery eviCore63015 Joint, Spine Surgery eviCore63017 Joint, Spine Surgery eviCore63020 Joint, Spine Surgery eviCore63030 Joint, Spine Surgery eviCore63035 Joint, Spine Surgery eviCore63040 Joint, Spine Surgery eviCore63042 Joint, Spine Surgery eviCore63043 Joint, Spine Surgery eviCore63044 Joint, Spine Surgery eviCore63045 Joint, Spine Surgery eviCore63047 Joint, Spine Surgery eviCore63048 Joint, Spine Surgery eviCore63050 Joint, Spine Surgery eviCore63051 Joint, Spine Surgery eviCore63056 Joint, Spine Surgery eviCore63057 Joint, Spine Surgery eviCore63075 Joint, Spine Surgery eviCore63076 Joint, Spine Surgery eviCore63081 Joint, Spine Surgery eviCore63082 Joint, Spine Surgery eviCore63650 Pain Management eviCore63655 Pain Management eviCore63685 Pain Management eviCore64451 Pain Management eviCore Add effective Sept 202064479 Pain Management eviCore64480 Pain Management eviCore64483 Pain Management eviCore64484 Pain Management eviCore64490 Pain Management eviCore64491 Pain Management eviCore64492 Pain Management eviCore64493 Pain Management eviCore64494 Pain Management eviCore64495 Pain Management eviCore64510 Pain Management eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
30430 Select Outpatient Services BCBSNM
Page 4June 2020
64520 Pain Management eviCore64561 Select Outpatient Services BCBSNM64581 Select Outpatient Services BCBSNM64625 Pain Management eviCore Add effective Sept 202064633 Pain Management eviCore64634 Pain Management eviCore64635 Pain Management eviCore64636 Pain Management eviCore64716 Select Outpatient Services BCBSNM64732 Select Outpatient Services BCBSNM64734 Select Outpatient Services BCBSNM64771 Select Outpatient Services BCBSNM64999 Select Outpatient Services BCBSNM67900 Select Outpatient Services BCBSNM69714 Select Outpatient Services BCBSNM69715 Select Outpatient Services BCBSNM69717 Select Outpatient Services BCBSNM69718 Select Outpatient Services BCBSNM69930 Select Outpatient Services BCBSNM70336 Advanced Imaging eviCore70450 Advanced Imaging eviCore70460 Advanced Imaging eviCore70470 Advanced Imaging eviCore70480 Advanced Imaging eviCore70481 Advanced Imaging eviCore70482 Advanced Imaging eviCore70486 Advanced Imaging eviCore70487 Advanced Imaging eviCore70488 Advanced Imaging eviCore70490 Advanced Imaging eviCore70491 Advanced Imaging eviCore70492 Advanced Imaging eviCore70496 Advanced Imaging eviCore70498 Advanced Imaging eviCore70540 Advanced Imaging eviCore70542 Advanced Imaging eviCore70543 Advanced Imaging eviCore70544 Advanced Imaging eviCore70545 Advanced Imaging eviCore70546 Advanced Imaging eviCore70547 Advanced Imaging eviCore70548 Advanced Imaging eviCore70549 Advanced Imaging eviCore70551 Advanced Imaging eviCore70552 Advanced Imaging eviCore70553 Advanced Imaging eviCore70554 Advanced Imaging eviCore70555 Advanced Imaging eviCore71250 Advanced Imaging eviCore71260 Advanced Imaging eviCore71270 Advanced Imaging eviCore71275 Advanced Imaging eviCore71550 Advanced Imaging eviCore71551 Advanced Imaging eviCore71552 Advanced Imaging eviCore71555 Advanced Imaging eviCore72125 Advanced Imaging eviCore72126 Advanced Imaging eviCore72127 Advanced Imaging eviCore72128 Advanced Imaging eviCore72129 Advanced Imaging eviCore72130 Advanced Imaging eviCore72131 Advanced Imaging eviCore72132 Advanced Imaging eviCore72133 Advanced Imaging eviCore72141 Advanced Imaging eviCore72142 Advanced Imaging eviCore72146 Advanced Imaging eviCore72147 Advanced Imaging eviCore72148 Advanced Imaging eviCore72149 Advanced Imaging eviCore72156 Advanced Imaging eviCore72157 Advanced Imaging eviCore72158 Advanced Imaging eviCore72159 Advanced Imaging eviCore72191 Advanced Imaging eviCore72192 Advanced Imaging eviCore72193 Advanced Imaging eviCore72194 Advanced Imaging eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 5June 2020
72195 Advanced Imaging eviCore72196 Advanced Imaging eviCore72197 Advanced Imaging eviCore72198 Advanced Imaging eviCore73200 Advanced Imaging eviCore73201 Advanced Imaging eviCore73202 Advanced Imaging eviCore73206 Advanced Imaging eviCore73218 Advanced Imaging eviCore73219 Advanced Imaging eviCore73220 Advanced Imaging eviCore73221 Advanced Imaging eviCore73222 Advanced Imaging eviCore73223 Advanced Imaging eviCore73225 Advanced Imaging eviCore73700 Advanced Imaging eviCore73701 Advanced Imaging eviCore73702 Advanced Imaging eviCore73706 Advanced Imaging eviCore73718 Advanced Imaging eviCore73719 Advanced Imaging eviCore73720 Advanced Imaging eviCore73721 Advanced Imaging eviCore73722 Advanced Imaging eviCore73723 Advanced Imaging eviCore73725 Advanced Imaging eviCore74150 Advanced Imaging eviCore74160 Advanced Imaging eviCore74170 Advanced Imaging eviCore74174 Advanced Imaging eviCore74175 Advanced Imaging eviCore74176 Advanced Imaging eviCore74177 Advanced Imaging eviCore74178 Advanced Imaging eviCore74181 Advanced Imaging eviCore74182 Advanced Imaging eviCore74183 Advanced Imaging eviCore74185 Advanced Imaging eviCore74261 Advanced Imaging eviCore74262 Advanced Imaging eviCore74263 Advanced Imaging eviCore74712 Advanced Imaging eviCore74713 Advanced Imaging eviCore75635 Advanced Imaging eviCore76376 Advanced Imaging eviCore76377 Advanced Imaging eviCore76380 Advanced Imaging eviCore76390 Advanced Imaging eviCore76391 Advanced Imaging eviCore Add effective Sept 202076497 Advanced Imaging eviCore76498 Advanced Imaging eviCore76975 Advanced Imaging eviCore Add effective Sept 202077014 Radiation Oncology eviCore77021 Advanced Imaging eviCore77022 Advanced Imaging eviCore77046 Advanced Imaging eviCore Add effective Sept 202077047 Advanced Imaging eviCore Add effective Sept 202077048 Advanced Imaging eviCore Added April 202077049 Advanced Imaging eviCore Added April 202077078 Advanced Imaging eviCore77084 Advanced Imaging eviCore77371 Radiation Oncology eviCore77372 Radiation Oncology eviCore77373 Radiation Oncology eviCore77385 Radiation Oncology eviCore77386 Radiation Oncology eviCore77387 Radiation Oncology eviCore77401 Radiation Oncology eviCore77402 Radiation Oncology eviCore77407 Radiation Oncology eviCore77412 Radiation Oncology eviCore77423 Radiation Oncology eviCore77424 Radiation Oncology eviCore77425 Radiation Oncology eviCore77520 Radiation Oncology eviCore77522 Radiation Oncology eviCore77523 Radiation Oncology eviCore77525 Radiation Oncology eviCore77600 Radiation Oncology eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 6June 2020
77605 Radiation Oncology eviCore77610 Radiation Oncology eviCore77615 Radiation Oncology eviCore77620 Radiation Oncology eviCore77750 Radiation Oncology eviCore77761 Radiation Oncology eviCore77762 Radiation Oncology eviCore77763 Radiation Oncology eviCore77767 Radiation Oncology eviCore77768 Radiation Oncology eviCore77770 Radiation Oncology eviCore77771 Radiation Oncology eviCore77772 Radiation Oncology eviCore77778 Radiation Oncology eviCore78012 Advanced Imaging eviCore78013 Advanced Imaging eviCore78014 Advanced Imaging eviCore78015 Advanced Imaging eviCore78016 Advanced Imaging eviCore78018 Advanced Imaging eviCore78020 Advanced Imaging eviCore78070 Advanced Imaging eviCore78071 Advanced Imaging eviCore78072 Advanced Imaging eviCore78075 Advanced Imaging eviCore78102 Advanced Imaging eviCore78103 Advanced Imaging eviCore78104 Advanced Imaging eviCore78140 Advanced Imaging eviCore Removed April 202078185 Advanced Imaging eviCore78195 Advanced Imaging eviCore78201 Advanced Imaging eviCore78202 Advanced Imaging eviCore78205 Advanced Imaging eviCore Remove effective Sept 202078206 Advanced Imaging eviCore Remove effective Sept 202078215 Advanced Imaging eviCore78216 Advanced Imaging eviCore78226 Advanced Imaging eviCore78227 Advanced Imaging eviCore78230 Advanced Imaging eviCore78231 Advanced Imaging eviCore78232 Advanced Imaging eviCore78258 Advanced Imaging eviCore78261 Advanced Imaging eviCore78262 Advanced Imaging eviCore78264 Advanced Imaging eviCore78265 Advanced Imaging eviCore78266 Advanced Imaging eviCore78278 Advanced Imaging eviCore78290 Advanced Imaging eviCore78291 Advanced Imaging eviCore78300 Advanced Imaging eviCore78305 Advanced Imaging eviCore78306 Advanced Imaging eviCore78315 Advanced Imaging eviCore78320 Advanced Imaging eviCore Remove effective Sept 202078445 Advanced Imaging eviCore78456 Advanced Imaging eviCore Add effective Sept 202078457 Advanced Imaging eviCore78458 Advanced Imaging eviCore78579 Advanced Imaging eviCore78580 Advanced Imaging eviCore78582 Advanced Imaging eviCore78597 Advanced Imaging eviCore78598 Advanced Imaging eviCore78600 Advanced Imaging eviCore78601 Advanced Imaging eviCore78605 Advanced Imaging eviCore78606 Advanced Imaging eviCore78607 Advanced Imaging eviCore Remove effective Sept 202078608 Advanced Imaging eviCore78609 Advanced Imaging eviCore78610 Advanced Imaging eviCore78630 Advanced Imaging eviCore78635 Advanced Imaging eviCore78645 Advanced Imaging eviCore78647 Advanced Imaging eviCore Remove effective Sept 202078650 Advanced Imaging eviCore78660 Advanced Imaging eviCore
Blue Cross Blue Shield of New Mexico
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
Page 11June 2020
0313T Select Outpatient Services BCBSNM0314T Select Outpatient Services BCBSNM0315T Select Outpatient Services BCBSNM0316T Select Outpatient Services BCBSNM0317T Select Outpatient Services BCBSNM0394T Radiation Oncology eviCore0395T Radiation Oncology eviCore0406T Select Outpatient Services BCBSNM0407T Select Outpatient Services BCBSNMA4290 Select Outpatient Services BCBSNMA4575 Select Outpatient Services BCBSNMA4604 Sleep Medicine eviCore
A7027 Sleep Medicine eviCoreA7028 Sleep Medicine eviCoreA7029 Sleep Medicine eviCoreA7030 Sleep Medicine eviCoreA7031 Sleep Medicine eviCoreA7032 Sleep Medicine eviCoreA7033 Sleep Medicine eviCoreA7034 Sleep Medicine eviCoreA7035 Sleep Medicine eviCoreA7036 Sleep Medicine eviCoreA7037 Sleep Medicine eviCoreA7038 Sleep Medicine eviCoreA7039 Sleep Medicine eviCoreA7044 Sleep Medicine eviCoreA7045 Sleep Medicine eviCoreA7046 Sleep Medicine eviCoreA9513 Radiation Oncology eviCore Added April 2020A9543 Radiation Oncology eviCore Added April 2020A9590 Radiation Oncology eviCore Add effective Sept 2020A9606 Radiation Oncology eviCoreC8900 Advanced Imaging eviCoreC8901 Advanced Imaging eviCoreC8902 Advanced Imaging eviCoreC8903 Advanced Imaging eviCoreC8905 Advanced Imaging eviCoreC8906 Advanced Imaging eviCoreC8908 Advanced Imaging eviCoreC8909 Advanced Imaging eviCoreC8910 Advanced Imaging eviCoreC8911 Advanced Imaging eviCoreC8912 Advanced Imaging eviCoreC8913 Advanced Imaging eviCoreC8914 Advanced Imaging eviCoreC8918 Advanced Imaging eviCoreC8919 Advanced Imaging eviCoreC8920 Advanced Imaging eviCoreC8931 Advanced Imaging eviCoreC8932 Advanced Imaging eviCoreC8933 Advanced Imaging eviCoreC8934 Advanced Imaging eviCoreC8935 Advanced Imaging eviCoreC8936 Advanced Imaging eviCoreC9757 Joint, Spine Surgery eviCore Add effective Sept 2020E0470 Sleep Medicine eviCoreE0471 Sleep Medicine eviCoreE0485 Sleep Medicine eviCore Add effective Sept 2020E0486 Sleep Medicine eviCore Add effective Sept 2020E0561 Sleep Medicine eviCoreE0562 Sleep Medicine eviCoreE0601 Sleep Medicine eviCoreE0745 Select Outpatient Services BCBSNME0748 Joint, Spine Surgery eviCoreE0749 Joint, Spine Surgery eviCoreE0760 Select Outpatient Services BCBSNME0765 Select Outpatient Services BCBSNME0770 Select Outpatient Services BCBSNMG0219 Advanced Imaging eviCoreG0235 Advanced Imaging eviCoreG0252 Advanced Imaging eviCoreG0260 Pain Management eviCore Remove effective Sept 2020G0277 Select Outpatient Services BCBSNMG0297 Advanced Imaging eviCoreG0339 Radiation Oncology eviCoreG0340 Radiation Oncology eviCoreG0398 Sleep Medicine eviCoreG0399 Sleep Medicine eviCoreG0400 Sleep Medicine eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 12June 2020
G0458 Radiation Oncology eviCore Remove effective Sept 2020G6001 Radiation Oncology eviCoreG6002 Radiation Oncology eviCoreG6003 Radiation Oncology eviCoreG6004 Radiation Oncology eviCoreG6005 Radiation Oncology eviCoreG6006 Radiation Oncology eviCoreG6007 Radiation Oncology eviCoreG6008 Radiation Oncology eviCoreG6009 Radiation Oncology eviCoreG6010 Radiation Oncology eviCoreG6011 Radiation Oncology eviCore
G6012 Radiation Oncology eviCoreG6013 Radiation Oncology eviCoreG6014 Radiation Oncology eviCoreG6015 Radiation Oncology eviCoreG6016 Radiation Oncology eviCoreG6017 Radiation Oncology eviCore Added April 2020G9143 Molecular and Genetic Lab eviCoreL8600 Select Outpatient Services BCBSNML8614 Select Outpatient Services BCBSNML8615 Select Outpatient Services BCBSNML8616 Select Outpatient Services BCBSNML8617 Select Outpatient Services BCBSNML8618 Select Outpatient Services BCBSNML8619 Select Outpatient Services BCBSNML8621 Select Outpatient Services BCBSNML8622 Select Outpatient Services BCBSNML8623 Select Outpatient Services BCBSNML8624 Select Outpatient Services BCBSNML8627 Select Outpatient Services BCBSNML8628 Select Outpatient Services BCBSNML8629 Select Outpatient Services BCBSNML8690 Select Outpatient Services BCBSNML8691 Select Outpatient Services BCBSNML8693 Select Outpatient Services BCBSNMM0076 Pain Management eviCore Added April 2020S1090 Select Outpatient Services BCBSNMS2118 Joint, Spine Surgery eviCore Added April 2020S2120 Select Outpatient Services BCBSNMS3800 Molecular and Genetic Lab eviCoreS3840 Molecular and Genetic Lab eviCoreS3841 Molecular and Genetic Lab eviCoreS3842 Molecular and Genetic Lab eviCoreS3844 Molecular and Genetic Lab eviCore Added April 2020S3845 Molecular and Genetic Lab eviCoreS3846 Molecular and Genetic Lab eviCoreS3850 Molecular and Genetic Lab eviCore Added April 2020S3852 Molecular and Genetic Lab eviCoreS3854 Molecular and Genetic Lab eviCoreS3861 Molecular and Genetic Lab eviCoreS3865 Molecular and Genetic Lab eviCoreS3866 Molecular and Genetic Lab eviCoreS3870 Molecular and Genetic Lab eviCoreS8037 Advanced Imaging eviCoreS8042 Advanced Imaging eviCoreS8080 Advanced Imaging eviCore Removed April 2020S8085 Advanced Imaging eviCoreS8092 Advanced Imaging eviCore
Blue Cross Blue Shield of New Mexico
Procedure Code Service/Category Managed By 2020 Updates
Page 13June 2020
