Provider-Administered Precertification Drug List
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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.
No material clinical or coverage changes in this revision.
Precertification and Coverage Criteria
Precertification conditions
Covered when precertification is obtained for listed drugs administered in specified settings.
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
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.
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.
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.
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
Where Precertification Applies
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)
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