Changes in prior authorization for Blue Cross NC Medicare Advantage members effective January 1, 2025

Effective January 1, 2025, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will require prior authorization for some codes related to the following services for Medicare Advantage members:

• Laboratory / Genetic Testing
• Codes associated with Gender Affirmation Services
• Behavioral Health / Mental Health services

The complete list of codes requiring prior authorization are below and will be added to the Blue Medicare HMO / PPO and Experience Health Medicare Advantage^℠ (HMO):

Laboratory / Genetic Testing: 81162, 81226, 81263, 81292, 81295, 81298, 81317, 81406, 81407, 81408, 81432, 81445, 81450, 81455, 81479, 81542, 88291.

Gender Affirmation Services: 19303, 53420, 53425, 53430, 54125, 54520, 54690, 55866, 55970, 55980, 56625, 56800, 56805, 57106, 57110, 57296, 57335, 58150, 58180, 58260, 58262, 58275, 58290, 58291, 58541, 58542, 58543, 58544, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573, 58720.

Behavioral Health / Mental Health when diagnosis is substance abuse: 90837, G0129, G0176, G0177, G0410, G0411.