Blue KC Commercial Prior Authorization and Notification List
Member IDs that begin with prefix RKC, RKQ, RRK, RRN, RKN, or RUK are for our Medicare Advantage network. YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ, or YJT are for our Affordable Care Act network.
To access Prior Authorization forms for MA/ACA members use Prior Authorizations Forms.
For Federal Employee Program (FEP) members, please refer to the appropriate service brochures for services that require Prior Approval (https://www.fepblue.org/plan-brochures) OR call the customer service phone number on the back of the member’s ID card. Effective 2/1/2020, Blue KC discontinued accepting pre-determination requests. However, providers may continue submitting pre-determination requests for Federal Employee Program (FEP) and Joint Administrative Account (JAA) lines of business. You can access the e-forms for these pre-determination requests here.
Prior Authorization General Request for Elective Surgery, Procedure, Service or DME
The following services require Prior Authorization (or notification):
- All scheduled elective surgical admissions
-
All medical admissions
- Acute Inpatient (hospital) admissions
- Acute Rehab facilities
- Inpatient Hospice
- Long-term care facilities (LTAC & SNF)
- All Clinical Trials
- All items and services from out-of-network providers require prior authorization for HMO and EPO plans.
- All Organ and Tissue Transplants (excluding corneal transplants)
- Exceeding OT/PT/ST Benefit Limits for Developmental and Physical Disorders
-
The following codes J3490, J3590, J9999 and C9399 are unlisted and do not require PA for all drugs associated with them; however, the following drugs, as well as all new drugs, that are listed under one of these codes DO require PA for all lines of business:
J3490 — Prevymis (letermovir)
J3590/C9399 — Zynteglo (betibeglogene autotemcel)
J3490/C9399 — Nulibry (fosdenopterin)
J3590/C9399 — Skysona (Elivaldogene autotemcel)
C9399 — Empaveli (pegcetacoplan)
C9399 — Enspryng (satralizumab-mwge)
C9399 — Tegsedi (inotersen)
C9399 — Vivimusta (bendamustine hcl)
C9399/J3590 — Briumvi (ublituximab)
C9399/J3590 — Leqembi (lecanemab-itmb)
C9399/J9999 — Lunsumio (mosunetuzumab-axgb)
C9399/J3590 — Lamzede (velmanase alfa-tycv)
C9399/J3590 — Altuviiio (antihemophilic factor (recombinant), Fc-VWF-XTEN fusion protein-ehtl)
C9399/J9999 — Zynyz (retifanlimab-dlwr)
C9399/J3490 — Syfovre (pegcetacoplan (intravitreal))
If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance.
Additionally, the following services require Prior Authorization regardless of place of service or level of care:
| Service Category | Description | Codes |
| Gastric Restrictive (Bariatric) Surgery | Gastric Restrictive (Bariatric) Procedures | 43644, 43770, 43771, 43772, 43773, 43774, 43775, 43843, 43845, 43846 |
| Behavioral Health | 0362T, 0373T, 90867, 90868, 90869, 90870, 96116, 96121, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158 | |
| Blepharoplasty & Ptosis Repair | Blepharoplasty | 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909 |
| Breast Surgery | Augmentation Mammoplasty | 19325 |
| Mastectomy for Gynecomastia | 19300 | |
| Reduction Mammaplasty | 19318 | |
| Related Procedures to Other Breast Surgeries or Procedures | 19303, 19316, 19328, 19330, 19340, 19357, 19342, 19350, 19361, 19364, 19367, 19368, 19369, 19370, 19371, 19380 | |
| Bone Growth Stimulators | Bone Growth Stimulators | 20974, 20975, 20979, E0747, E0748, E0749, E0760 |
| Cancer Care | Other Miscellaneous Cancer Care Procedures | 17107, 17108, 19294, 58674, 96547, 96548, |
| Optune | E0766, A4555 | |
| Proton Beam Radiation Therapy | 77520, 77522, 77523, 77525 | |
| Radiopharmaceutical | A9513, A9596, A9601, A9607 | |
| Stereotactic Radiosurgery | 63620, 63621, 77371, 77372, 77373, 77425, 77432, 77435, G0339, G0340 | |
| Cardiac Devices | Ventricular Assist Device | 33975, 33976, 33979 |
| Pacemakers | C1605 | |
| Phrenic Nerve Stimulator | 33276, 33277, 33278, 33279, 33280, 33281, 33287, 33288 | |
| Cardiac Procedures | Cardiac Defect Repair | 0569T, 0570T, 93228, 93229, 93580, 93590 |
| Electrophysiologic Study and Implantable Cardioverter Defibrillator Insertion | 93620 | |
| Miscellaneous Cardiac Procedures | 33267, 33268, 33269, 33900, 33901, 33902, 33903, 33904, 36516 | |
| Digestive System procedures | Miscellaneous GI procedures | 43279, 43330, 43331, 43497, 43659 |
| Durable Medical Equipment (DME) | Myo-Electric Prostheses | L5856, L5857, L5858, L5859, L5961, L6026, L6205, L6715, L6880, L6882, L6925, L6935, L6945, L6955, L6965, L6975, L7007, L7008, L7009, L7040, L7045, L7170, L7180, L7185, L7190, L7191, L7259, L7700, L8701, L8702 |
| Cochlear Devices | 69930, L8614, L8615, L8616, L8617, L8619, S2235 | |
| Cranial Remodeling Orthosis | S1040 | |
| Sleep Apnea Devices | E0467, E0486 | |
| Infusion Pumps Implantable | E0782, E0783, E0785, E0786 | |
| Insulin Pump, External Ambulatory | A9274, E0784 | |
| Speech Generating Devices | E2500, E2502, E2504, E2506, E2508, E2510, E2511, E2512, E2599 | |
| Wheelchairs (and accessories) | E0627, E0637, E0950, E0951, E0952, E0953, E0954, E0955, E0956, E0957, E0960, E0967, E0969, E0970, E0973, E0983, E0984, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E1011, E1012, E1017, E1028, E1035, E1036, E1220, E1229, E1230, E1231, E1232, E1233, E1239, E1399, E2298, E2301, E2310, E2311, E2312, E2313, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2331, E2340, E2341, E2342, E2343, E2351, E2361, E2368, E2369, E2370, E2373, E2374, E2375, E2376, E2377, E2378, E2397, E2613, E2614, E2615, E2616, E2617, E2620, E2621, E2626, E2627, E2628, E2629, E2630, K0005, K0008, K0009, K0010, K0011, K0012, K0013, K0014, K0108, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899 | |
| Decubitus Care | E0183 | |
| Home Ventilator | E0466, E0468 | |
| ENT Procedures | Rhinoplasty | 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465, 30468 |
| Septoplasty | 30520 | |
| Uvulopalatopharyngoplasty | 42145 | |
| Facet Joint Procedures | Facet Joint Denervation / Facet Neurotomy | 64628, 64629 |
| Fertility Related Procedures | Cryopreservation; embryo(s) | 89258, S4030, S4031 |
| Cryopreservation; sperm | 89259 | |
| Cryopreservation, mature oocyte(s) | 89337 | |
| Storage, (per year); embryo(s) | 89342 | |
| Storage, (per year); sperm/semen | 89343 | |
| Storage, (per year); reproductive tissue, testicular/ovarian [when specified as ovarian tissue] | 89344 | |
| Storage (per year); oocyte(s) | 89346 | |
| Thawing for cryopreserved; embryo(s) | 89352 | |
| Thawing of cryopreserved; sperm/semen, each aliquot | 89353 | |
| Thawing of cryopreserved; reproductive tissue, testicular/ovarian [when specified as ovarian tissue] | 89354 | |
| Thawing of cryopreserved; egg(s), each aliquot | 89356 | |
| Misc Orthotic And Prosthetic Procedures or Devices | L1320, L5783, L5841 | |
| Gender Affirmation | Gender Affirmation | 15847, 15877, 17380, 54400, 54401, 54405, 55970, 55980, 57291, 57292, 58720, J9226 |
| GI Tract Imaging | Imaging of digestive tract done from the inside of the digestive tract | 91110, 91111 |
| Imaging of colon using capsule endoscope, with interpretation and report | 91113 | |
| Medical-Pharmacy | 90283, 90284, 90378, C1772, C9047, J0129, J0172, J0174, J0175, J0180, J0202, J0217, J0218, J0219, J0221, J0222, J0223, J0224, J0225, J0256, J0257, J0490, J0491, J0517, J0565, J0567, J0584, J0593, J0596, J0597, J0598, J0599, J0600, J0606, J0638, J0739, J0775, J0791, J0775, J0791, J0801, J0802, J0879, J0889, J0895, J0896, J1203, J1290, J1300, J1301, J1302, J1303, J1304, J1322, J1323, J1325, J1426, J1427, J1428, J1429, J1411, J1412, J1413, J1442, J1447, J1448, J1449, J1459, J1460, J0491, J1305, J1306, J1440, J1551, J1554, J1555, J1556, J1557, J1558, J1559, J1560, J1561, J1562, J1566, J1568, J1569, J1572, J1575, J1599, J1602, J1632, J1743, J1745, J1747, J1786, J1823, J1931, J1932, J2182, J2267, J2277, J2323, J2326, J2327, J2329, J2350, J2357, J2506, J2507, J2508, J2562, J2779, J2781, J2786, J2793, J2796, J3032, J3055, J3111, J3241, J3245, J3247, J3262, J3263, J3316, J3358, J3380, J3385, J3393, J3394, J3397, J3398, J3399, J3401, J3520, J7168, J7169, J7170, J7171, J7175, J7177, J7178, J7179, J7180, J7181, J7182, J7183, J7185, J7186, J7187, J7188, J7189, J7190, J7192, J7193, J7194, J7195, J7197, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7208, J7209, J7210, J7211, J7212, J7213, J7214, J7318, J7320, J7321, J7322, J7324, J7326, J7327, J7328, J7329, J7331, J7332, J7351, J7352, J7354, J7355, J7686, J9021, J9023, J9029, J9035, J9037, J9039, J9042, J9056, J9057, J9058, J9059, J9061, J9063, J9118, J9119, J9153, J9173, J9177, J9203, J9204, J9210, J9223, J9227, J9228, J9229, J9247, J9269, J9272, J9273, J9274, J9281, J9286, J9298, J9299, J9306, J9309, J9311, J9312, J9316, J9317, J9318, J9319, J9321, J9331, J9332, J9333, J9334, J9345, J9347, J9348, J9349, J9350, J9353, J9354, J9355, J9356, J9358, J9359, J9361, J9376, J9380, J9381, Q2043, Q4074, Q5101, Q5103, Q5104, Q5107, Q5108, Q5109, Q5110, Q5111, Q5112, Q5113, Q5114, Q5115, Q5116, Q5117, Q5118, Q5119, Q5120, Q5121, Q5122, Q5123, Q5125, Q5126, Q5127, Q5129, Q5130, Q5133, Q5134, Q5138 | |
| Miscellaneous | CAR T-cell Therapy | 0537T, 0538T, 0539T, 0540T, Q2041, Q2042, Q2053, Q2054, Q2055, Q2056 |
| Compression garments | A6523, A6525, A6526, A6527, A6528, A6529, A6574, A6580 | |
| Eye Procedures | 66174, 65778, 65779, 66175, 67516 | |
| Grafting of autologous fat | 15771, 15772 | |
| Lipectomy | 15878, 15879 | |
| Low-Level Laser Therapy | 97037 | |
| Obstructive Sleep Apnea procedures | 21685 | |
| Other medical items or services | D7284, D9954, D9955 | |
| Panniculectomy | 15830 | |
| Scleral/Contact Lenses | S0515, V2627, V2531, V2628 | |
| Skin & Skin Substitutes | 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 15777, Q4101, Q4102, Q4105, Q4106, Q4107, Q4114, Q4116, Q4121, Q4122, Q4128, Q4132, Q4133, Q4151, Q4154, Q4159, Q4186, Q4187 | |
| Vascular embolization or occlusion | 37241, 37243 | |
| Molecular & Genetic Testing To use Avalon’s Prior Authorization system, a user account is required. To request a new user account, email your lab's name, username(s), email address, office phone number, supervisor's name, and email address to Avalon-PAS-Help@avalonhcs.com. For questions or general assistance call 844-227-5769, or fax requests to 813-751-3760. |
81099, 81120, 81121, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81168, 81170, 81171, 81172, 81173, 81175, 81176, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81187, 81188, 81189, 81191, 81192, 81193, 81194, 81200, 81201, 81202, 81203, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219,81220, 81221, 81222, 81223, 81224, 81225, 81226, 81227, 81228, 81229, 81231, 81232, 81233, 81234, 81235, 81236, 81237, 81238, 81239, 81240, 81241, 81242, 81243, 81244, 81245, 81246, 81247, 81249, 81250, 81251, 81252, 81254, 81255, 81256, 81257, 81258, 81259, 81260, 81265, 81266, 81269, 81270, 81271, 81272, 81273, 81274, 81275, 81276, 81277, 81278, 81279, 81283, 81284, 81285, 81286, 81287, 81288, 81290, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81304, 81305, 81306, 81307, 81308, 81309, 81310, 81311, 81312, 81314, 81315, 81316, 81317, 81318, 81319, 81320, 81321, 81322, 81323, 81324, 81325, 81328, 81329, 81330, 81331, 81333, 81334, 81335, 81336, 81338, 81339, 81343, 81344, 81345, 81346, 81347, 81348, 81349, 81350, 81351, 81352, 81353, 81355, 81357, 81360, 81361, 81363, 81364, 81381, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81410, 81411, 81412, 81413, 81414, 81415, 81416, 81417, 81419, 81430, 81431, 81432, 81433, 81434, 81435, 81436, 81437, 81438, 81439, 81441, 81442, 81443, 81445, 81448, 81449, 81450, 81451, 81455, 81456, 81457, 81458, 81459, 81460, 81462, 81463, 81464, 81465, 81479, 81518, 81519, 81520, 81521, 81522, 81523, 81539, 81541, 81542, 81546, 81552, 81595, 81599, 84999, 86849, 87999, 88199, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 89240, G9143, S3840, S3844, S3845, S3846, S3849, S3854, S3861, S3865, S3866, S3870, 0001U, 0005U, 0016U, 0017U, 0022U, 0023U, 0026U, 0027U, 0030U, 0034U, 0037U, 0040U, 0046U, 0047U, 0048U, 0049U, 0084U, 0087U, 0089U, 0101U, 0102U, 0103U, 0111U, 0118U, 0129U, 0155U, 0169U, 0171U, 0172U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0211U, 0221U, 0222U, 0230U, 0231U, 0232U, 0233U, 0234U, 0235U, 0236U, 0237U, 0238U, 0239U, 0242U, 0244U, 0245U, 0246U, 0250U, 0252U, 0268U, 0269U, 0270U, 0271U, 0272U, 0273U, 0274U, 0276U, 0277U, 0282U, 0287U, 0326U, 0334U, 0359U, 0364U, 0379U, 0388U, 0391U, 0396U, 0400U, 0405U, 0409U, 0414U, 0428U, 0439U, 0440U, 0449U, 0444U, 0448U, 0460U, 0461U, 0465U, 0467U, 0469U, 0470U, 0471U, 0473U, 0474U, 0475U, 0742T, S3800 | |
| Neurostimulators | 0720T, 0786T, 0787T, 20974, 20975, 61863, 61864, 61867, 61868, 61885, 61886, 61889, 61891, 61892, 63688, 64553, 64555, 64561, 64568, 64569, 64570, 64575, 64581, 64582, 64583, 64584, 64585, 64590, 64595, 95961, 95962, A4555, C1767, E0748, E0749, L8679, L8681, L8682, L8683, L8685, L8687, L8688 | |
| Nursing Care | Private Duty Nursing services | S9123, S9124, T1000, T1001, T1002, T1003, T1030, T1031 |
| Orthognathic Procedures | Orthognathic Surgery | 21050, 21060, 21070, 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21249, 29804, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7995, D7996 |
| Orthopedic Procedures | Shoulder Arthroscopy, Acromioplasty & Rotator Cuff Repair | 23472 |
|
Pain Management
For many groups, Interventional Pain Management Procedures are handled by eviCore (effective March 01, 2023). To submit a prior authorization request through eviCore please contact them directly via phone: 1-888-333-9082 (7:00 am-8:00 pm CST); fax: 1-800-540-2406 or web: www.evicore.com. The request form can be downloaded here. If you require web assistance, please contact eviCore via phone 1-800-575-4594 or E-mail: online@evicore.com. Members in groups not delegated to eviCore require prior authorization for these services through Blue KC. |
0784T, 0785T, 22526, 22527, 27096, 62263, 62264, 62280, 62281, 62282, 62287, 62292, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 64625, 64633, 64634, 64635, 64636, 64451, 64479, 64480, 64483, 64484, 64490, 64491, 64492, 64493, 64494, 64495, 64510, 64520, 01939, 01940, 01941, 01942, 0213T, 0214T, 0215T, 0216T, 0217T, 0218T, 0627T, 0628T, 0629T, 0630T, G0260, M0076, 62350, 62351, 62360, 62361, 62362, 63650, 63655, 63663, 63664, 63685 | |
| Radiology Services For many groups, free-standing and outpatient high-tech radiology services such as MRI, MRA, CT, CTA, PET, echocardiogram, nuclear imaging and cardiac imaging are handled by eviCore. To submit a prior authorization request through eviCore please contact them directly via phone: 1-888-693-3211 (7:00 am-8:00 pm CST); fax: 1-888-693-3210 or web: www.evicore.com. The request form can be downloaded here. If you require web assistance, please contact eviCore via phone 1-800-575-4594 or E-mail: online@evicore.com. Members in groups not delegated to eviCore require prior authorization for these services through Blue KC. |
Hi Tech Radiology Services & Cardiac Imaging (MRI, MRA, Nuclear Medicine, CT, CTA, Echocardiogram, Stress Echocardiogram, PET Scans) | 0042T, 0398T, 0439T, 0609T, 0610T, 0611T, 0612T, 0623T, 0624T, 0625T, 0626T, 0633T, 0634T, 0635T, 0636T, 0637T, 0638T, 0648T, 0649T, 0865T, 0866T, 70336, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 71250, 71260, 71270, 71271, 71275, 71550, 71551, 71552, 71555, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74261, 74262, 74263, 74712, 74713, 75557, 75559, 75561, 75563, 75565, 75571, 75572, 75573, 75574, 75580, 75635, 76376, 76377, 76380, 76391, 76497, 76498, 77021, 77022, 77046, 77047, 77048, 77049, 77078, 77084, 78429, 78430, 78431, 78432, 78433, 78434, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, 78499, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816, 78999, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93319, 93350, 93351, 93356, 93593, 93594, 93595, 93596, 93597, C8900, C8901, C8902, C8903, C8905, C8906, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, C8920, C8921, C8922, C8923, C8924, C8925, C8926, C8928, C8929, C8930, C9762, C9763, C9791, G0235, G0252, S8035, S8037, S8042, S8092 |
| Respiratory System Procedures | Nasal/Sinus Endoscopy | 31295, 31296, 31297, 31298 |
| Sleep Studies | 95805, 95807, 95808, 95810, 95811 | |
| Spinal Procedures Procedure level authorization does not apply to members in the following plan types: Missouri Health Insurance Pool or Employer/Labor Union Funded Health Plans (also known as ASO or JAA). All inpatient hospital admissions require prior authorization. |
Musculoskeletal Procedures For many groups, Musculoskeletal Procedures are handled by TurningPoint (effective August 01, 2024). To submit a prior authorization request through TurningPoint, please contact them directly via phone: 1-855-469-1650/ 816-414-3244 (8:00 am-5:00 pm CST); fax 816-226-6311/833-374-0035 or web: https://myturningpoint-healthcare.com/. To request access to the TurningPoint Web portal, call the phone numbers listed above. Members in groups not delegated to TurningPoint may require prior authorization for these services through Blue KC. |
20930, 20931, 20936, 20937, 20938, 20939, 22100, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22510, 22511, 22512, 22513, 22514, 22515, 22532, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22854, 22855, 22856, 22858, 22859, 22861, 22864, 22899, 23040, 23044, 23100, 23101, 23105, 23106, 23107, 23120, 23125, 23130, 23190, 23195, 23333, 23334, 23335, 23395, 23397, 23400, 23405, 23406, 23410, 23412, 23415, 23420, 23430, 23440, 23450, 23455, 23460, 23462, 23465, 23466, 23470, 23473, 23474, 23616, 23700, 23800, 23802, 24160, 24164, 24300, 24360, 24361, 24362, 24363, 24365, 24366, 24370, 24371, 25332, 25441, 25442, 25443, 25444, 25445, 25446, 25449, 25800, 25805, 25810, 25820, 25825, 27033, 27090, 27091, 27120, 27122, 27146, 27147, 27151, 27156, 27158, 27161, 27125, 27130, 27132, 27134, 27137, 27138, 27236, 27275, 27278, 27279, 27280, 27284, 27286, 27299, 27331, 27332, 27333, 27403, 27405, 27407, 27409, 27412, 27415, 27416, 27418, 27420, 27422, 27424, 27425, 27427, 27428, 27429, 27437, 27438, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487, 27488, 27570, 27580, 27599, 27700, 27702, 27703, 27704, 27860, 27870, 28446, 29805, 29806, 29807, 29819, 29820, 29821, 29822, 29823, 29824, 29825, 29826, 29827, 29828, 29850, 29851, 29855, 29856, 29860, 29861, 29862, 29863, 29866, 29867, 29868, 29870, 29871, 29873, 29874, 29875, 29876, 29877, 29879, 29880, 29881, 29882, 29883, 29884, 29885, 29886, 29887, 29888, 29889, 29892, 29899, 29914, 29915, 29916, 29999, 62380, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63197, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63295, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, 0098T, C1062, C9757, G0289, J7330, S2112, S2118, S2350, S2351 |
| Transplant | G0455, S2053, S2054, S2055, S2060, S2061, S2065, S2102, 0584T, 0585T, 0586T, 32850, 32851, 32852, 32853, 32854, 32855, 32856, 33927, 33928, 33929, 33930, 33933, 33935, 33940, 33944, 33945, 38240, 38241, 38243, 44132, 44133, 44135, 44136, 44705, 44720, 44721, 47133, 47135, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 48160, 48550, 48551, 48552, 48554, 50300, 50320, 50323, 50325, 50327, 50328, 50329, 50340, 50360, 50365, 50547 | |
| TurningPoint For many groups, Musculoskeletal Procedures are handled by TurningPoint (effective August 01, 2024). To submit a prior authorization request through TurningPoint, please contact them directly via phone: 1-855-469-1650/ 816-414-3244 (8:00 am-5:00 pm CST); fax 816-226-6311/833-374-0035 or web: https://myturningpoint-healthcare.com/. To request access to the TurningPoint Web portal, call the phone numbers listed above. Members in groups not delegated to TurningPoint may require prior authorization for these services through Blue KC. |
Cardiac Codes | 33249, 33270, 33285, 33361, 33362, 33363, 33364, 33365, 33366, 33418, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 0483T, 0484T, 0571T, 0572T, E0616, G0448, K0606, 33229, 33230, 33231, 33233, 33236, 33237, 33240, 33241, 33243, 33244, 33262, 33263, 33264, 33271, 33274, 33275, 33286, 33340, 33367, 33368, 33369, 33405, 33406, 33410, 33411, 33412, 33413, 33419, 33430, 33440, 33465, 33475, 33510, 33511, 33512, 33513, 33514, 33516, 33517, 33518, 33519, 33521, 33522, 33523, 33530, 33533, 33534, 33535, 33536, 33572, 35302, 35303, 35304, 35305, 35371, 35372, 35556, 35558, 35566, 35571, 35583, 35585, 35587, 35656, 35661, 35666, 35671, 35700, 35881, 35883, 35884, 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37232, 37233, 37234, 37235, 37236, 37237, 37238, 37239, 37246, 37247, 37248, 37249, 75710, 75716, 75736, 75820, 75822, 78445, 78457, 78458, 92920, 92921, 92925, 92928, 92929, 92933, 92934, 92937, 92938, 92943, 92944, 93462, 93565, 93566, 93567, 93568, 93745, 0573T, 0574T, 0580T, 4110F, C1721, C1722, C1764, C1777, C1779, C1785, C1786, C1874, C1875, C1876, C1877, C1880, C1882, C1895, C1896, C1898, C1899, C1900, C2617, C2619, C2620, C2621, C2623, C2625, C9600, C9601, C9602, C9603, C9604, C9605, C9606, C9607, C9608, S2205, S2206, S2207, S2208, S2209, 33202, 33203, 33206, 33207, 33208, 33210, 33211, 33212, 33213, 33214, 33221, 33224, 33227, 33228, 33225, 33477 |
To submit a prior authorization request you may also fax or mail your request. For the timeliest response, fax the request to 816-926-4253 using this form.
Requests may also be mailed to:
Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878
Please include any supporting medical information in your fax. Please allow at least 36 hours (to include one business day) from the date of receipt of all necessary information for a determination. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.
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