CurrentBlue Cross Blue Shield - MinnesotaPolicy PRV20021MN-2602

Provider-Administered Precertification Drug List

Lists provider-administered drugs that require precertification when given in a provider's office, outpatient facility, or home health setting; gene therapy/cellular immunotherapy products on the list require precertification in any setting. Applies to providers submitting claims to Blue Cross Blue Shield Minnesota.

Policy Summary

PayerBlue Cross Blue Shield - Minnesota

PolicyProvider-Administered Precertification Drug List

Policy CodePolicy PRV20021MN-2602

Change TypeNo material changes

Effective Date

Next Review Date

Key ActionObtain precertification through the Provider-Administered Drug Review Program before administering any listed drug in an office, outpatient facility, or home health setting (gene therapies require precertification in any setting).

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

~300drugs listed

monthlyupdate frequency

office/outpatient/homesettings requiring PA

any settinggene therapy PA

Precertification and Coverage Criteria

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Precertification conditions

Covered when precertification is obtained for listed drugs administered in specified settings.

Precertification requirements: 1) Drug appears on the Provider-Administered Precertification Drug List; 2) For standard listed drugs, administration occurs in a provider's office, outpatient facility, or home health setting; for items marked with '+', precertification is required when administered in any setting.

Annotations: '+' = Gene Therapy/Cellular Immunotherapy; '*' = PA required for non-oncology indications only; oncology indications for those with '*' are not managed via PA.

Oncology indications for products marked with * on the Provider‑Administered Precertification Drug List are not managed via precertification under this list. The list note states: * PA required for non‑oncology indications only; oncology indications are not managed via PA. (See product annotations on the list and the list update notice.)

Provider Requirements and Prior Authorization

Prior Authorization

Precertification requirement

Precertification is required for all drugs on the Provider-Administered Precertification Drug List when administered in a provider's office, outpatient facility, or home health setting. Treatments designated with a plus (+) as Gene Therapy/Cellular Immunotherapy require precertification for administration in any place of treatment.

Provider must obtain precertification before administration to avoid claim denials.
Gene Therapy/Cellular Immunotherapy products (marked with +) require precertification regardless of place of treatment.
The drug list is updated monthly and subject to change without notice.

Billing Rule

Provider billing and documentation

Providers should follow standard billing rules and verify coverage prior to service. Ensure claims include correct drug name, NDC or HCPCS code when applicable, and place of service. Missing or incorrect billing information may result in payment delays or denials.

Include NDC or HCPCS and appropriate administration CPT code on the claim.
Document place of service and precertification number on the claim.
For oncology indications noted with an asterisk (*), PA requirements may differ — see policy details.

Note

How to access policy and requirements

Providers must follow the Provider-Administered Drug Review Program precertification process for listed products. Online policies and the full drug list are available at MN-Policies.Exploremyplan.com (select 'Provider-Administered Drug Policies').

Precertification requests submitted through the program must reference PRV20021MN-2602 when applicable.
The drug list and policy guidance are updated monthly; confirm you are referencing the current list.
Products marked with + (Gene Therapy/Cellular Immunotherapy) and products with special notes (e.g., * for certain indications) have specific handling — consult the online policy.

Denial Risk

Precertification required

Failure to obtain required precertification for listed provider-administered drugs when administered in a provider's office, outpatient facility, or home health setting may result in claim denials or nonpayment.

Claims for drugs on the list administered without precertification are subject to denial.
Gene Therapy/Cellular Immunotherapy products administered anywhere without required precertification are subject to denial.
Refer to the online policy for appeal and exception procedures.

Policy Background

This document is an administrative list that identifies which provider‑administered drugs require precertification under Blue Cross Blue Shield Minnesota's Provider‑Administered Drug Review Program. Precertification is required for listed drugs when administered in a provider's office, outpatient facility, or home health setting; items designated as Gene Therapy/Cellular Immunotherapy (marked with +) require precertification in any place of treatment. The policy and the full, monthly updated drug list are available online at MN‑Policies.Exploremyplan.com under 'Provider‑Administered Drug Policies.'

List Annotations and Definitions

List annotations

'+' annotationIndicates Gene Therapy/Cellular Immunotherapy product; these items require precertification when administered in any place of treatment.

'*' annotationPA required for non-oncology indications only; oncology indications for products marked with '*' are not managed via prior authorization under this list.

Product name ownershipProduct names are the property of their respective owners.

List update frequencyThis list is updated monthly and is subject to change without notice.

Where to find policiesOnline policies can be found at MN-Policies.Exploremyplan.com by selecting 'Provider-Administered Drug Policies.'

Where Precertification Applies

Step Therapy

Site-of-care precertification requirements

Precertification is required when listed drugs are administered in a provider's office, outpatient facility, or home health setting; gene therapy/cellular immunotherapy products (marked '+') require precertification in any place of treatment.

Applies to administration in office, outpatient facility, or home health for standard listed drugs
Applies in any setting for drugs marked with '+' (Gene Therapy/Cellular Immunotherapy)