Provider Central

Bilateral Services

• Annual review; no edits

Cardiology Services

• Annual review

Community Mental Health Centers

• Annual review; no edits

Durable Medical Equipment

• Update to compression stocking/garment information
• Edited Wheelchairs/Mobility Assisted Devices information

Early Intervention

• Annual review; no edits

Free-standing Ambulatory Surgical Center (ASC)

• Annual review; template update
• Inclusion of existing reimbursement information for implants
• NOC/unlisted surgical procedure codes not on ASC fee schedule are not reimbursed

Home Health Care

• Annual review; template update
• Edited to clarify existing benefit information: as of January 1, 2024, Blue Cross no longer requires a prior authorization for Commercial Plans (a referral may still be required)

Home Infusion

• Annual review; template update
• Edited to clarify that Blue Cross does not reimburse IV RN or a per diem if the medication administered was billed/paid under the member’s pharmacy benefit
• Added existing codes within HIT payment system: S9061, S9340, S9341, S9342, S9343, S9370
• Edited to clarify existing NDC requirements

Hospice

• Annual review; template update
• Edited to clarify existing general benefit information that certain services may require a referral

Immunizations

• Annual review; no edits

Inpatient Acute Medical Admission

• Annual review; new template
• Edited to clarify existing authorization process for transfers
• Added revised readmissions payment policy effective for discharge dates on or after May 1, 2024

Non-Reimbursable Services

• Updated links for non-reimbursed lists for professional providers and facility providers

Obstetrical and Maternity Care

• Annual review; no edits

Oncology

• Annual review; no edits

Orthopedic Services

• Annual review; no edits

Skilled Nursing Facility

• Annual review; template update

Surgery-Professional

• Annual review
• Added reference to Laboratory and Pathology payment policy

Telehealth (Telemedicine) – Medical Services

• Annual review
• Added reimbursement information for online digital evaluation and management services, online adaptive interview services, and interprofessional/telephone/internet/electronic health record services
• Edited to clarify requirements for telehealth section

Telehealth (Telemedicine) – Mental Health

• Annual review
• Added reimbursement information for online digital evaluation and management services, online adaptive interview services, and interprofessional/telephone/internet/electronic health record services
• Edited to clarify requirements for telehealth section

Urgent Care Center

• Annual review
• Removed references to dates greater than one year ago