The following other medical services require prior authorization.
All scheduled medical and surgical admissions
Blepharoplasty (download request form)
15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909
Chiropractic services performed by an out-of-network provider
Cochlear Implants
69930, L8614, L8619
Dental Implants and Bone Grafts
21050, 21060, 21070, 21120, 21121, 21122, 21123, 21125, 21127, 21141, 21142, 21143, 21144, 21145, 21146, 21147, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21240, 21242, 21243, 21244, 21245, 21246, 21247, 21248, 21240, 29804
Elective Pre-Operative Observation Status
Genetic Testing for Breast Cancer
S3818, S3819, S3820
Genetic Testing for Colon Cancer
S3828, S3829, S3830, S3831, S3833, S3834
Mastectomy for Gynecomastia
19300
MRI ordered by a chiropractor
Organ and Tissue Transplants (excluding cornea transplants)
Out of network services for HMO members
PET Scans
78459, 78491, 78492, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816
Reduction Mammoplasty (download request form)
19318
Rhinoplasty
30400, 30410, 30420, 30435, 30450, 30460, 30462
Sclerothearpy
36470, 36471, S2202
Varicose Vein Treatment (download request form)
S2202, 36470, 36471, 36475, 36476, 36478, 36479, 37500, 37760, 37761, 37799
To submit a prior authorization request for one of these types of other services, download a request form. For the most timely response, fax the request to 816-502-4910. Requests may also be mailed to:
Blue Cross and Blue Shield of Kansas City
Attention: Prior Authorization, Mail Stop B5A1
P.O. Box 411878
Kansas City, MO 64141-1878
Please include any supporting medical information in your fax. Please allow at least two business days from the date of receipt of all necessary information for a determination. To check the status of a prior authorization, call the Customer Service number listed on the member ID card.