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CPT Code List Added for Enhanced Cardiology Review Program Effective April 1, 2023
On February 23, 2023, Blue Cross and Blue Shield of North Carolina announced additional codes to the Enhanced Cardiology Review program effective April 1, 2023.
For provider convenience, visit the Carelon (formerly known as AIM) Prior Review Code List.
Effective April 1, 2023, additional procedures requiring medical necessity review were added to the Enhanced Cardiology program for Fully Insured Commercial Members only, offered through Carelon (formerly AIM). For most services, the review will take place prior to rendering the service, but where needed, post-service review will be accommodated. Providers are strongly encouraged to verify that an authorization has been obtained before scheduling or in some cases after performing any elective cardiovascular service.
As of March 13, 2023, providers should contact Carelon (formerly AIM) for authorization of services on or after April 1, 2023, for the following procedures:
- Percutaneous Coronary Intervention (PCI), such as coronary stents and balloon angioplasty *
- Arterial Duplex *
- Peripheral Revascularization *
- Implantable Cardioverter – Defibrillators
- Cardiac Resynchronization Therapy
- Permanent Pacemakers
* If a post services authorization becomes necessary for the following modalities: Arterial duplex, Peripheral revascularization and Percutaneous coronary intervention, the provider will need to initiate the request through Carelon (formerly AIM) within 10 business days of the date of service.
To place an order request, you can submit prior authorization requests to Carelon (formerly AIM) using one of the following methods:
Online
Get fast, convenient online service via the Carelon (formerly AIM) ProviderPortal (registration required). ProviderPortal is available 24 hrs/day, 7 days/week. Visit the Provider Portal to begin.
By phone
Call Carelon (formerly AIM) toll-free at 866-455-8414
Hours: Monday – Friday 8:00 – 5:00 PM (EDT)
If you have other colleagues in your practice who will be submitting prior authorization requests, we encourage you to share this notice with them.
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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