Policy Updates Medical Policy & Clinical GuidelinesCommercialMay 1, 2023

Transition to Carelon Medical Benefits Management, Inc.* MRI Breast Clinical Appropriateness Guidelines

Effective August 1, 2023, Anthem Blue Cross and Blue Shield will transition the clinical criteria for medical necessity review of MRI Breast to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines:

  • Oncologic Imaging
  • Chest Imaging

As part of this transition of clinical criteria, the following procedures will be subject to prior authorization at Carelon Medical Benefits Management:

CPT® code

Description

77046

Magnetic resonance imaging, breast, without contrast material; unilateral

77047

Magnetic resonance imaging, breast, without contrast material; bilateral

77048

Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis) when performed; unilateral

77049

Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis) when performed; bilateral

 

 

HCPCS

 Description

C8903

Magnetic resonance imaging with contrast, breast; unilateral

C8905

Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral

C8906

Magnetic resonance imaging with contrast, breast; bilateral

C8908

Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon Medical Benefits Management in one of several ways:

Access Carelon Medical Benefits Management’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.

For questions related to guidelines, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

MULTI-BCBS-CM-021989-23-CPN21926

PUBLICATIONS: May 2023 Provider News