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Program Updates: Radiology/Imaging Services 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 as noted below. Both of these programs are administered by eviCore healthcare (eviCore).

eviCore will conduct Prior Authorization/Medical Necessity Determination (PA/MND) reviews of the services represented by the recently approved procedure codes below when rendered on or after August 15, 2021.

   0648T

   0649T

Additionally, eviCore will conduct PA/MND reviews of the services represented by the procedure codes below when rendered on or after September 1, 2021.

   0623T

   0624T

   0625T

   0626T

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

For more information about this 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, weekdays, 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.

eviCore healthcare is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the provision of Prior Authorization and/or Medical Necessity Review (PA/MND) of certain nonemergency radiology services.

Published on: July 15, 2021, 08:29 a.m. ET
Last updated on: July 13, 2021, 08:50 a.m. ET