Dear Provider,
HNS recently learned that, effective 10/1/2024, BCBSNC intends to add most Physical Therapy codes to the list of codes requiring prior authorization for its fully insured plans, and that this change would apply to all provider types, including chiropractors.
HNS staunchly opposes the requirement for HNS providers to obtain prior authorization for any service and has been in communication with BCBSNC representatives over the past several weeks concerning this forthcoming change.
Importantly, we are advocating for HNS providers to be exempt from this change and are working with BCBSNC to obtain additional details. However, we wanted to share the following with you now:
- Effective 10/1/2024, for all BCBSNC full insured plans, most Physical Therapy codes will require prior plan approval, including, but not limited to:
97010, 97012, 97014, 97016, 97024, 97026, 97032, 97034, 97035,
97110, 97112, 97124, 97140, 97530, 97750, 97760, 97763
- This requirement will apply to all provider types, not just chiropractors.
- As indicated above, this requirement will only apply to BCBS fully insured plans, meaning it will not apply to self-funded groups, FEP, or SHP.
Over the coming weeks, HNS will be focused on learning more details about the change and advocating for HNS providers to be exempt from it. While HNS hopes BCBS grants this exemption, the outcome is far from certain. As such, at this time, all HNS providers should be aware that this change is slated to take effect 10/1/2024.
We will be communicating with the entire HNS Network again once we have more information to share.
Sincerely,
HNS
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