eviCore Program Updates: Radiology/Imaging Services and Cardiology Imaging

Effective February 1, 2021, Horizon BCBSNJ will implement changes to the services included as part of our Radiology/Imaging Services Program and our Cardiology Imaging Program, both administered by eviCore healthcare (eviCore).

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

• 0609T
• 0610T
• 0611T
• 0612T
• C9762
• C9763

Review the complete list of services that require PA/MND review as part of these programs.

For more information about these and other eviCore programs, visit HorizonBlue.com/evicore. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

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

PA/MND reviews

To submit a PA/MND request to eviCore (or to validate that a PA/MND was requested and/or approved) please:

• Visit eviCore.com or
• Call 1-866-496-6200, between 7 a.m. and 7 p.m., Eastern Time

Review the guidelines eviCore uses to conduct PA/MND reviews as part of this program.