Certain Treatments for Prostate Cancer Now Require Prior Authorization
CareFirst BlueCross BlueShield and CareFirst BlueChoice, Inc. (collectively, “CareFirst”) is continually working with healthcare delivery partners to optimize Utilization Management (UM) strategies to increase efficiencies and control costs while ensuring members receive affordable, quality care. Prior Authorization helps balance access with appropriate utilization services.
Effective February 1, 2024, CareFirst will require prior authorization for all commercial lines of business for Medical Policy 5.01.020 Xofigo (radium-223 dichloride) Injection for Treatment of Prostate Cancer.
What codes now require prior authorization?
The following codes will now require prior authorization:
- Current Procedural Terminology (CPT®) – 79101
- HCPCS – A9606
Next steps
You can find this medical policy in our Medical Policy database.
If you need assistance submitting a prior authorization, review our authorization training under ‘CareFirst Essentials’ on the Learning and Engagement Center.