blue cross blue shield association - 2019 …...obtained through blue cross and blue shield of...

Procedure Code Service/Category

15824 Select Outpatient Services




20930 Joint, Spine Surgery

















2019 Commercial Outpatient Benefit Preauthorization Procedure Code List

This list includes Current Procedural Terminology (CPT®) and/or Healthcare Common Procedure Coding System (HCPCS)

codes related to services/categories for which benefit preauthorization may be required as of Jan. 1, 2019, for commercial

plans/networks, such as those listed below:

- PPO (PPO)

- Blue Choice Preferred PPOSM (BCE)

- Blue Choice PPOSM (BCS)

- Blue OptionsSM/Blue Choice OptionsSM (BCO)

This is not an exhaustive listing of all codes. Codes may change, and this list may be updated throughout the year. 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. Benefit preauthorization for some services/categories must be

obtained through Blue Cross and Blue Shield of Illinois (BCBSIL). Benefit preauthorization for other services/categories must

be obtained through a utilization management vendor.

It is imperative that providers check eligibility and benefits for each patient prior to rendering services to confirm

benefits, benefit preauthorization/pre-notification requirements and utilization management vendors that must be

used, if applicable. Providers may submit online eligibility and benefits inquiries (electronic 270 transactions) via the

Availity® Provider Portal at availity.com or their preferred web vendor portal. Services performed without benefit

preauthorization, if required, will be denied for payment and providers may not seek reimbursement from BCBSIL

members. Obtaining benefit preauthorization/pre-notification is not a substitute for confirming eligibility and benefits.

December 2018

Blue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue

Cross and Blue Shield Association


























22526 Pain Management






















December 2018
















































December 2018































70336 Advanced Imaging

















December 2018
















































December 2018







































75557 Cardiology

75559 Cardiology

75561 Cardiology

C8934 Advanced Imaging

75563 Cardiology

75565 Cardiology

75571 Cardiology

75572 Cardiology

75573 Cardiology

December 2018

75574 Cardiology








77014 Radiation Oncology







































December 2018












































78414 Cardiology

78428 Cardiology


78451 Cardiology

December 2018

78452 Cardiology

78453 Cardiology

78454 Cardiology



78459 Cardiology

78466 Cardiology

78468 Cardiology

78469 Cardiology

78472 Cardiology

78473 Cardiology

78481 Cardiology

78483 Cardiology

78491 Cardiology

78492 Cardiology

78494 Cardiology

78496 Cardiology

78499 Cardiology






























December 2018
















81162 Molecular and Genetic Lab
































December 2018
















































December 2018













94660 Sleep Medicine













0004M Molecular and Genetic Lab




0042T Advanced Imaging

0095T Joint, Spine Surgery


0159T Advanced Imaging




0228T Pain Management






0312T Select Outpatient Services





December 2018


0394T Radiation Oncology

0395T Radiation Oncology

0399T Cardiology



A0430 Select Outpatient Services




A4604 Sleep Medicine

















A9606 Radiation Oncology




















December 2018





E0470 Sleep Medicine





E0745 Select Outpatient Services

E0748 Joint, Spine Surgery

E0749 Joint, Spine Surgery




G0219 Advanced Imaging



G0260 Pain Management

G0277 Select Outpatient Services


G0339 Radiation Oncology


G0398 Sleep Medicine




















G9143 Molecular and Genetic Lab

L8600 Select Outpatient Services



December 2018















S1090 Select Outpatient Services

S2120 Select Outpatient Services

S2360 Joint, Spine Surgery

S2361 Joint, Spine Surgery

S3800 Molecular and Genetic Lab












S8037 Advanced Imaging





Please note that the fact that a service has been preauthorized/pre-notified is not a guarantee of payment. Benefits will be determined

once a claim is received and will be based upon, among other things, the member’s eligibility and the terms of the member’s certificate of

coverage applicable on the date services were rendered.

CPT copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

Availity is a trademark of Availity, LLC, a separate company that operates a health information network to provide electronic information

exchange services to medical professionals. Availity provides administrative services to BCBSIL. BCBSIL makes no endorsement,

representations or warranties regarding any products or services provided by third party vendors such as Availity. If you have any questions

about the products or services provided by such vendors, you should contact the vendor(s) directly.

Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an

association of independent Blue Cross and Blue Shield Plans.

December 2018

blue cross blue shield association - 2019 …...obtained through blue cross and blue shield of...

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