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Commercial Prior Authorization Code Changes, Effective April 1, 2021

Posted December 28, 2020

On March 15, 2021, Blue Cross and Blue Shield of Illinois (BCBSIL) will update its list of procedure codes requiring prior authorization for some commercial members to reflect new, replaced or retired codes, effective for dates of service on or after April 1, 2021. The changes will apply to some BCBSIL members with the commercial PPO products listed below:

  • PPO
  • Blue Choice Preferred PPOSM
  • Blue Choice PPOSM
  • Blue OptionsSM/Blue Choice OptionsSM
  • Blue High Performance NetworkSM (Blue HPNSM)

Changes will be made specifically to procedure codes processed through AIM Specialty HealthSM for services provided to the above-referenced members in the following care categories:

  • Advanced Imaging (some codes being retired)
  • Joint and Spine Surgery (codes being added)
  • Molecular and Genetic Lab (some codes being retired, and codes being added)
  • Pain Management (codes being added)
  • Radiation Oncology (codes being added)

The 2021 Commercial Outpatient Medical Surgical Code List is available on the Support Materials (Commercial) page in the Utilization Management section of our Provider website. This list is updated throughout the year.

Check Eligibility and Benefits: To identify if a service requires prior authorization for our members, check eligibility and benefits through the Availity® Provider Portal or your preferred web vendor.

Checking eligibility and/or benefit information and/or obtaining prior authorization 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, including, but not limited to, exclusions and limitations applicable on the date services were rendered. If you have any questions, call the number on the member's ID card. Regardless of any prior authorization or benefit determination, the final decision regarding any treatment or service is between the patient and the health care provider.

AIM Specialty Health (AIM) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. 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.