Blue Cross and Blue Shield of New Mexico – Medicare Plans
Providers should contact EviCore to obtain Pre-Certifications for services listed below. Services performed without a pre-authorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
Medical Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSNM.com for a list of codes that require authorization through BCBSNM as of 1/1/2024. If you have any questions, please contact BCBSNM using the number on the back of the member’s ID card.
Radiation Oncology CPT codes no longer require pre-authorization through EviCore as of 1/1/2024. Please refer to the Provider News/Updates notice at BCBSNM.com for a list of codes that require authorization through BCBSNM as of 1/1/2024. If you have any questions, please contact BCBSNM using the number on the back of the member’s ID card.
Medicare Membership:
Blue Cross Medicare Advantage (HMO) SM
Blue Cross Medicare Advantage (HMO-POS) SM
Blue Cross Medicare Advantage (PPO) SM
New Mexico Individual Medicare HMO
New Mexico Group Medicare HMO
New Mexico Group Medicare PPO
Providers should contact EviCore to obtain Pre-Certifications for services listed below. Services performed without a pre-authorization may be denied for payment, and the rendering provider may not seek reimbursement from the member.
Effective 12/14/2018, some Cardiology and Radiology services are no longer in scope for management by EviCore. Please see the Radiology and Cardiology code list for those codes managed by EviCore.
Obtain Authorization for:
Ultrasounds do not require pre-authorization as of 7/1/2023. Should you have any questions, please contact BCBSNM 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.
Effective 9/1/2019, ST, OT, PT, Chiropractic and Cardiology services are no longer in scope for management by EviCore. Please see the code lists located at evicore.com for codes managed by EviCore.
Lab Management Solutions-Molecular and Genomic Lab Testing
Musculoskeletal Services
Joint Surgery (Outpatient/Inpatient)
Spine Surgery (Outpatient/Inpatient)
Interventional Pain (Outpatient)
Outpatient Advanced Radiology Imaging
Outpatient Medical Oncology
Outpatient Radiation Therapy Solution
Outpatient Sleep
Outpatient Specialty Drug
Sleep
Musculoskeletal
Laboratory Management
Radiology
Post-Acute Care
Medical Drug Management
Need Help?
Registration Instructions
EviCore highly recommends providers take full advantage of the online capabilities at https://www.evicore.com/provider
Here you can request prior authorization, review our nationally accepted evidence-based guidelines, and receive announcements about program updates. Access requires only your email address and a brief registration.