Providers: To view the most accurate list of prior authorization requirements for your patient, we recommend you log in and use our prior authorization search solution.

Members: Work with your doctor to confirm the prior authorization requirements for the services listed in the PDF documents below.

Commercial Procedure and Service Codes

Commercial / Employer Groups & JAA prefixes incudes all prefixes excluding those explicitly listed below

• Commercial Prior Authorization Procedure and Service Code List
• Prior Authorization General Request for Elective Surgery, Procedure, Serivce or DME Form

ACA Procedure and Service Codes

Affordable Care Act (ACA) prefixes include YBD, YBG, YBS, YBM, YBT, YBX, YJV, YJW, YJJ, or YJT

• ACA Prior Authorization Procedure and Service Codes
• ACA Prior Authorization General Request for Elective Surgery, Procedure, Service or DME

MA Procedure and Service Codes

Medicare Advantage (MA) prefixes include RKC, RKQ, RRK, RRN, RKN, or RUK

• MA Prior Authorization Procedure and Service Code List
• MA Prior Authorization General Request for Elective Surgery, Procedure, Service or DME Form

Federal Employee Program (FEP) Procedures

FEP member ID numbers begin with the letter R and do not include a prefix.

• FEP Prior Authorization Requirements - See Section 3 of the Plan brochure or call the customer service number on the back of the member's ID card.
• FEP 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, J8999, 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 — Izervay (avacincaptad pegol)
  J3490 — Prevymis (letermovir (injectable))
  J3590 — ELFABRIO (pegunigalsidase alfa-iwxj)
  J3590 — Rystiggio (rozanolixizumab-noli)
  J3590 — Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)
  C9399 — Empaveli (pegcetacoplan)
  C9399 — Enspryng (satralizumab-mwge)
  C9399 — Tegsedi (inotersen)
  J3490/C9399 — Nulibry (fosdenopterin)
  J3590/C9399 — Beqvez (fidanacogene elaparvovec-dzkt)
  J3590/C9399 — Lamzede (velmanase alfa-tycv)
  J3590/C9399 — Lantidra (donislecel-jujn)
  J3590/C9399 — Lenmeldy (atidarsagene autotemcel)
  J3590/C9399 — Rethymic (allogeneic processed thymus tissue–agdc)
  J3590/C9399 — Skysona (Elivaldogene autotemcel)
  C9399/J8999 — Lytgobi (futibatinib)
  C9399/J9999 — Amtagvi (lifileucel)
  J3490/J3590/C9399 — Casgevy (exagamglogene autotemcel)
  J3490/J3590/C9399 — Omisirge (Omidubicel)
  
  If you have any questions or need help submitting a prior authorization, please call 816-395-3989 for assistance.

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.