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eviCore Program Update: Musculoskeletal Program for Pain Management

Horizon BCBSNJ will implement changes to the services included as part of our Musculoskeletal Program for pain management services program, administered by eviCore healthcare (eviCore).

eviCore will conduct Prior Authorization/Medical Necessity Determination (PA/MND) reviews of the additional Nuclear Medicine, Nuclear Cardiac Imaging and Echocardiogram services represented by the recently approved procedure codes below when rendered on or after February 1, 2021.

  • 0627T
  • 0628T
  • 0629T
  • 0630T

Effective for services to be provided after December 31, 2020, eviCore will no longer conduct PA/MND of the services represented by the following procedure codes as part of this program.

  • 0228T
  • 0229T
  • 0230T
  • 0231T

Learn more about our Musculoskeletal Program or review the complete lists of spine surgery services and pain management services for which eviCore conducts PA/MND on our behalf as part of this program.

If you have questions, please contact your Network Specialist.

eviCore healthcare supports Horizon BCBSNJ in the administration and utilization management review of certain musculoskeletal pain management and spine surgery services as part of our Musculoskeletal Program. eviCore Healthcare is independent from, and not affiliated with Horizon BCBSNJ or the Blue Cross Blue Shield Association. eviCore healthcare is a registered trademark of eviCore healthcare

CPT® is a registered trademark of the American Medical Association.

Published on: December 30, 2020, 06:52 a.m. ET
Last updated on: May 6, 2021, 04:18 a.m. ET