Blue Cross and Blue Shield of Montana - Healthy Montana Kids /Medicare Advantage Plans Provider Resources

Radiation Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024 for Medicare Advantage members only (Healthy Montana Kids is still applicable). If you have any questions, please contact BCBSMT using the number on the back of the member’s ID card.

Ultrasounds do not require pre-authorization as of 7/1/2023. Should you have any questions, please contact BCBSMT using the number on the back of the member's ID card. Please see the code lists located at evicore.com for codes managed by EviCore.

Blue Cross and Blue Shield of Montana contracted with EviCore to provide utilization management services for Medicare Advantage and Healthy Montana Kids. EviCore is an independent company that provides specialty medical benefits management for BCBSMT. Services requiring prior authorization through EviCore are outlined below

Providers should contact EviCore to obtain prior authorization for services listed below. Services performed without prior authorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.

Healthy Montana Kids (HMK) Membership

Obtain Authorization for:

       Molecular and Genetic Testing

       Radiation Therapy 

Medicare Advantage Membership:

Obtain Authorization for:

       Lab Management Solutions-Molecular and Genomic Lab Testing

       Outpatient Radiation Therapy Solution

       Specialty Drugs