January 2020 Update: Radiology/Imaging Services Program and Cardiology Imaging Program

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 additional Nuclear Medicine, Nuclear Cardiac Imaging and Echocardiogram services represented by the recently approved procedure codes below when rendered on or after January 1, 2020.

78434
93356
78830
78831
78832

Effective for services to be provided January 1, 2020, and after, eviCore will no longer conduct PA/MND of the services represented by the following procedure codes as part of these programs.

0482T
78205
78320
78607
78647
78710
78805
78806
78807
78206

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: November 29, 2019, 23:33 PM ET
Last updated on: November 26, 2019, 23:56 PM ET