WebPrior Authorization Required 3DI: 76376 3D Rendering W/O Postprocessing Yes: 3DI 76377 3D Rendering W Postprocessing: Yes BMRI: 77046 Magnetic resonance imaging, breast, without contrast material; unilateral Yes: BMRI 77047 Magnetic resonance imaging, ... Highmark Comprehensive Cardiology and Radiology Code List: WebSubmit prior authorization requests by fax using the forms listed below: Commercial prior authorization forms Select formulary General fax form Acute migraine agents CNS stimulants — high cumulative dose Immune modulating therapy Opioid management — Buprenorphine/naloxone (Bunavail ® /Suboxone ® /Zubsolv ®) and Buprenorphine …
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WebSep 23, 2024 · Highmark Blue Cross Blue Shield serves the 29 counties of western Pennsylvania and 13 counties of northeastern Pennsylvania. Highmark Blue Shield serves the 21 counties of central Pennsylvania and also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Web[{"id":39211,"versionId":16647,"title":"Highmark Post-PHE Changes","type":4,"subType":null,"childSubType":"","date":"4/7/2024","endDate":null,"additionalDate":null ... WebSection 10 Managed Care Referrals and Authorizations (Central Region Products) 10.2 Who can issue a referral The following parties can issue referrals: ! The member’s primary care physician ! A specialist authorized by Highmark Blue Shield to act as a … im with the band shirt