Sign In - Secure Provider Portal
BLUECONNECT
Providers
April 2023
In This Issue
► Note of appreciation from Dr. Cara Christ
► April updates, reminders, and tips
► Preview May 2023 code edit updates
► Waiver extended for PCP referral approvals
► May 1: More drugs to require site-of-service review
Check out our current
member ID card samples
May 1: Site-of-service validation review to be required for these drugs
Blue Cross® Blue Shield® of Arizona (BCBSAZ) has a current policy related to site-of-service requirements for certain infusion therapy medications. As part of the prior authorization process, we validate that the specified drug will be administered in the most appropriate setting.

Effective May 1, 2023, we are expanding the list of medications that will be subject to a site-of-service validation review during the prior authorization process. The newly added drugs are listed below. No later than May 1, we will add the site-of-service review indicator to these drugs, which are already included in the BCBSAZ prior authorization code list and lookup tool.

As a reminder, the preferred sites of service for these drugs are non-hospital outpatient facilities, including a physician’s office, a freestanding infusion center, and the patient’s home.
CODE(S) MEDICATION
J0791 Adakveo® (crizanlizumab-tmca)
J9042 Adcetris® (brentuximab vedotin)
J0225 Amvuttra® (vutrisiran)
J0739 Apretude (cabotegravir)
J9023 Bavencio® (avelumab)
C9339, J3590 BriumviTM (ublituximab-xiiy)
J2786 Cinqair® (reslizumab)
J0584 Crysvita® (burosumab-twza)
J9144 Darzalex Faspro® (daratumumab and hyaluronidase-fihj)
J3060 Elelyso® (taliglucerase alfa)
J1305 Evkeeza® (evinacumab-dgnb)
J0517 Fasenra® (benralizumab)
J9210 Gamifant® (emapalumab-lzsg)
J0223 Givlaari® (givosiran)
J0638 Ilaris® (canakinumab)
J3245 Ilumya® (tildrakizumab-asmn)
J9272 Jemperli (dostarlimab-gxly)
J9047 Kyprolis® (carfilzomib)
J1306 Leqvio® (inclisiran)
J9119 Libtayo® (cemiplimab-rwlc)
C9399, J3490 Nulibry® (fosdenopterin hydrobromide)
J9299 Opdivo® (nivolumab)
J9298 OpdualagTM (nivolumab/relatimab rmbw)
J0224 Oxlumo® (lumasiran)
J9316 Phesgo® (pertuzumab/trastuzumab/hyaluronidase-zzfx)
J1301 Radicava® (edaravone)
C9399, J3590 Revcovi® (elapegademase-lvlr)
J2353 Sandostatin® LAR Depot (octreotide acetate)
J2502 Signifor® LAR (pasireotide)
J2327 Skyrizi® (risankizumab-rzaa) IV
J1930 Somatuline® Depot (lanreotide)
C9399, J3490 Sunlenca® (lenacapavir) IV
90378 Synagis® (palivizumab)
J9022 Tecentriq® (atezolizumab)
J2356 Tezspire® (tezepelumab-ekko)
J3316 Triptodur® (triptorelin)
J9317 Trodelvy® (sacituzumab govitecan-hziy)
J1746 Trogarzo® (ibalizumab-uiyk)
J1823 Uplizna® (inebilizumab-cdon)
J9303 Vectibix® (panitumumab)
J2357 Xolair® (omalizumab)
J9352 Yondelis® (trabectedin)
Please note: The site-of-service review requirement applies to BCBSAZ commercial group and individual plans. It does not apply to Medicare Advantage, Federal Employee Program®, BlueCard® (out-of-area) plans, or plans managed by third-party administrators.

More information
For details about the evidence-based criteria we use for site-of-service reviews, see our site-of-service medical policy. If you have questions, please contact your provider liaison.
In This Issue
► Note of appreciation from Dr. Cara Christ
► April updates, reminders, and tips
► Preview May 2023 code edit updates
► Waiver extended for PCP referral approvals
► May 1: More drugs to require site-of-service review
Check out our current
member ID card samples
Blue Cross, Blue Shield, the Cross and Shield Symbols, MyBlue, BlueCard, Federal Employee Program, and FEP are registered service marks, and BluePathway and BlueJourney are service marks, of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.

CPT® (Current Procedural Terminology) codes are © 2023 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

© Blue Cross Blue Shield of Arizona, Inc. All rights reserved.
DISCLAIMER  |  PRIVACY POLICY  |  AZBLUE.COM
facebook instagram twitter linkedin TikTok youtube