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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.

Published on: December 30, 2020, 11:46 a.m. ET
Last updated on: April 27, 2021, 07:26 a.m. ET