Medicare Advantage Procedures
The information on this page is available for those providers who are Medicare Advantage-contracted with BCBSNE.
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- Medicare Advantage Provider Manual (Updated 03/22/24)
- Medicare Advantage Waiver of Liability
- 2024 Provider Excellence Program Booklet
- Annual Physical Exam Policy
- Blood and Blood Components Policy
- Chiropractic Care Policy
- Determination of Refractive State Policy
- Hearing Services Policy
- Inpatient Hospital Care Policy
- Medicare Advantage Provider Offset/Check Request Form
- Out of Area Travel for Organ and Tissue Transplants Policy
- SilverSneakers® Fitness Program Policy
- Skilled Nursing Facility Policy
- Vision Care Policy
- Worldwide Coverage Emergency and Urgent Care Policy
Medical Prior Authorizations
- Medicare Advantage Medical Policy Updates (09/22/2023)
- Medicare Services Prior Authorization List
- Medical Prior Authorization Request Form
- Ablation of Peripheral Nerves to Treat Pain
- Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry
- Bioengineered Skin and Soft Tissue Substitutes
- Computer-Assisted Musculoskeletal Surgical Navigation Orthopedic Procedure
- Cosmetic and Reconstructive Surgery
- Drug Eluting Sinus Stents
- Dynamic Posturography
- Implantable Bone Conduction and Bone-Anchored Hearing Aid
- Multimarker Testing Related to Ovarian Cancer
- Myoelectric Upper Limb Prosthesis
- Percutaneous Disc Procedures
Part B Drugs Prior Authorizations
- Part B Drugs that Require Prior Authorization List
- Medical Benefit Drug Request Form
- Abecma (idecabtagene vicleucel)
- Aduhelm (aducanumab-avwa)
- Alpha-1 Proteinase Inhibitors
- Benlysta (belimumab)
- Beovu® (brolucizumab-dbll)
- Botulinum Toxin Type A Injection
- Botulinum Toxin Type B (rimabotulinumtoxinB)
- Breyanzi (lisocabtagene maraleucel)
- Carvykti (ciltacabtagene autoleucel)
- Colony Stimulating Factors
- Cyramza (ramucirumab)
- Denosumab (Prolia Xgeva)
- Enzyme Replacement Therapy for Fabry Disease
- Enzyme Replacement Therapy for Gauchers Disease
- Enzyme Replacement Therapy for Mucopolysaccharidosis
- Enzyme Replacement Therapy for Pompe Disease
- Erythropoiesis Stimulating Agents
- Evenity (romosozumab)
- Evkeeza (evinacumab)
- Eylea® (aflibercept)
- Fabrazyme (agalsidase beta)
- General Drug Utilization Management Policy
- Hemgenix (etranacogene dezaparvovec-drlb)
- Hemophilia Class
- Ilaris (canakinumab)
- Immune Globulin Replacement Therapy
- Infliximab Policy
- Keytruda (pembrolizumab)
- Kymriah (tisagenlecleucel)
- Leqembi (lecanemab-irmb)
- Lumizyme (alglucosidase alfa)
- Luxturna (voretigene neparvovec-rzyl)
- Medical Benefit Oncology Drug Class Policy
- Nplate (romiplostim)
- Onpattro (patisiran)
- Opdivo® (nivolumab)
- Pulmonary Arterial Hypertension
- Radicava (edaravone)
- Ranibizumab
- Reblozyl (luspatercept-aamt)
- Spinraza (nusinersen)
- Tecartus (brexucabtagene autoleucel)
- Tecvayli (teclistamab-cqyv)
- Tepezza (teprotumumab-trbw)
- Tzield (teplizumab-mzwv)
- Vabysmo™ (faricimab-svoa)
- Xiaflex (collagenase clostridium histolyticum)
- Yescarta (axicabtagene ciloleucel)
- Yervoy (ipilimumab)
- Zilretta (triamcinolone acetonice)
- Zolgensma (onasemnogene abeparvovec)
- Advanced Illness and Frailty Exclusions Guide
- Annual Wellness Visit
- Breast Cancer Screening (BCS-E)
- Colorectal Cancer Screening (COL-E)
- Commonly Captured HCC Codes
- Glycemic Status Assessment for Patients with Diabetes (GSD)
- Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Survey
- Controlling Blood Pressure (CBP)
- CPT® II and ICD-10 codes for HEDIS® measures
- DMARD Therapy for Rheumatoid Arthritis
- Eye Exam for Patients with Diabetes (EED)
- Follow-Up After Emergency Department Visit for People with Multiple High-Risk Chronic Conditions (FMC)
- Health Outcomes Survey (HOS)
- Kidney Health Evaluation for Patients with Diabetes (KED)
- Medication Adherence
- Medication Reconciliation Post Discharge (MRP)
- Osteoporosis Management in Women Who had a Fracture (OMW)
- Plan All-Cause Readmissions (PCR)
- Statin Therapy for Patients with Cardiovascular Disease (SPC)
- Statin Use in Persons with Diabetes (SUPD)
- Transitions of Care (TRC)
- AIM Clinical Guidelines
- Detail Notice of Discharge
- Detailed Explanation of Non-Coverage
- Guidelines for Bundling Admissions
- Important Message from Medicare for Hospital Inpatient and Discharge
- LTACH Assessment Form
- Medicare Outpatient Observation Notice (MOON)
- Medical Records Routing Form
- Notice of Medicare Non-Coverage (NOMNC) Form
- SNF Rehabilitation Assessment Form
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