FLASH: Prior Authorizations for Vascular Interventions

Health Alliance^TM Medical Plans has expanded its partnership with EviCore to manage two additional prior authorization categories of service under the Vascular Intervention Program for our Health Alliance Commercial and Medicare members. For dates of service on or after August 12, 2024, providers must access EviCore on HealthAlliance.org to request prior authorizations on the following services.

Prior Authorization for vascular interventions has been expanded to include:

• Vascular embolization procedures.
• Endovascular intracranial procedures.

Providers can begin requesting authorizations on August 1, 2024, for dates of service on and after August 12, 2024. Services performed without authorization may be denied payment, and you may not seek reimbursement from members.

We are also pleased to announce that we have streamlined the authorization process for ALL of the vascular intervention procedures by introducing bundling of like CPT codes logic. Along with this addition, EviCore will be adding seven additional CPT codes (37241-37244, 61624, 61630, 61635) for prior authorization. The goal is to simplify the number of codes that you are entering to account for unknown scenarios that may occur during a procedure.  EviCore is instituting bundling logic that will place related CPT codes into a “bundle basket” of vascular codes for the authorization. Therefore, if the CPT code that you request for a vascular intervention procedure on a member has a related “bundle basket” of codes associated with it, then the additional codes in the bundle basket will automatically become part of the review request.

• Related codes will be primarily grouped according to procedure type and anatomic region.
• If this alert is received, you will continue to enter any other codes on your list to determine if prior authorization is needed for the remaining codes.
• Right/left/bilateral specification for the entire bundle are allowed where appropriate.
• Multiple bundles may be requested for the same case if different anatomic regions are indicated
• The vascular intervention “bundle basket” codes can be found by clicking this link.

Note: Column 3 of the Vascular Intervention Code List includes the name of the bundle category. All codes with the same category name are in the same “bundle basket.” Office staff only need to request the “bundle basket” by submitting ONE of the CPT codes from within that group.

Please contact our Customer Solutions team or your provider relations specialist with any questions.