October 1, 2020
This accommodation will end on Dec. 31, 2020. Starting Jan. 1, 2021, our standard process will resume.
With the rapidly evolving COVID-19 public health crisis, Blue Cross and Blue Shield of Illinois (BCBSIL) is temporarily simplifying access to chest computed tomography (CT). This will allow our members to get access to the care they need for the duration of the public health emergency.
As of March 2, 2020, providers that request prior authorization through eviCore healthcare (eviCore) for chest CT scans with a COVID-19 diagnosis will receive an approval without the need for clinical documentation.
We are also temporarily waiving the need for members to notify us when they are scheduled to have a chest CT scan.
This applies to chest CT scans rendered from March 2, 2020 until further notice.
This is for all our members with prior authorization delegated to eviCore. This applies to commercial fully-insured, self-funded group and retail members, as well as Blue Cross Medicare Advantage (PPO)SM, Blue Cross Community Health PlansSM (BCCHPSM) and Blue Cross Community MMAI (Medicare-Medicaid Plan)SM members. This does not apply to any BCBSIL members with an HMO benefit plan [HMO Illinois®, Blue Advantage HMOSM, Blue Precision HMOSM, Blue FocusCareSM, BlueCare DirectSM, Blue Cross Medicare Advantage (HMO)SM].
The prior authorization requests with Current Procedural Terminology (CPT®) codes 71250, 71260 or 71270 and the associated diagnosis codes for COVID-19 will be approved without clinical documentation.
CPT codes for chest CT scan:
Associated diagnosis codes:
- U07.1 (COVID-19 acute respiratory disease)
- 19Z03.818 (possible exposure to COVID-19)
- Z20.828 (actual exposure to COVID-19)
Please note that the fact that a service has been preauthorized 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. If you have any questions, contact the number on the member’s ID card.
eviCore is an independent specialty medical benefits management company that provides utilization management services for BCBSIL. eviCore is wholly responsible for its own products and services. BCBSIL makes no endorsement, representations or warranties regarding any products or services provided by eviCore.
CPT copyright 2019 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.