Preauthorization CPT/HCPCS code list for utilization management
Governs the list of CPT and HCPCS procedure codes for which benefit preauthorization may be required and the documentation or prior authorization routing for Blue Cross Blue Shield - New Mexico members and providers.
Multiple CPT codes (e.g., 77520, 77522, 77523, 77600–77620, 77750–77778, 78012–78015, etc.) were added with a 1/1/24 effective annotation and require prior authorization documentation (history and physical, results of previous diagnostics/procedure report).
Several CPT codes previously routed/prior-authorized prior to 9/1/2019 have 'Removed 12/31/23' annotations.
For many listed nuclear medicine and imaging CPT codes the prior authorization vendor is specified as eviCore with phone and URL.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.