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Musculoskeletal Management Tools and Criteria |
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Program Overview | Utilization and Quality Management | Program Tools and Criteria
Criteria
New and Revised CPT Codes for Musculoskeletal Management Pain Program Effective 1/1/2012-
Please be advised that revisions to several CPT Codes in the Musculoskeletal Pain Management Program will become effective 1/1/2012. The change will contain the replacement of CPT Codes 64626, 64627, 64622, and 64623 with CPT Codes 64633, 64634, 64635, and 64636 respectively. The descriptions for the following CPT Codes will be updated: 22520, 22521, 22522, 27096, 62287, 62310, 62311, 62318, 62319, and 77003. For providers who are required to obtain prior authorization or medical necessity determination based on the member‘s health plan benefits, please review the summary analysis of the new and revised CPT Codes for 2012 to assist you with the selection process during this transition.
Musculoskeletal Pain Management Criteria V1.2012- Effective 1/1/2012
Musculoskeletal Pain Management Criteria for Horizon BCBS NJ V1.1.2012- Effective 1/1/2012
Musculoskeletal Pain Management Criteria for WellCare V1.0.2012- Effective 4/1/2012
Fax Forms
Horizon Musculoskeletal Management Fax Form
WellCare Musculoskeletal Management Fax Form
Tutorials
Provider Web Submission for Musculoskeletal Management
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