[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-288905-105":53,"doc-detail-288905-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","2025-commercial-outpatient-specialty-pharmacy-prior-authorization-codes-effective-112025","2025 Commercial Outpatient Specialty Pharmacy Prior Authorization Codes - Effective 1/1/2025","","2025 commercial outpatient specialty pharmacy prior authorization code list defines when Blue Cross and Blue Shield of Illinois (BCBSIL) or Carelon Medical Benefits Management may require benefit prior approval before administering specialty infusion site-of-care or provider-administered drug therapies. The searchable table maps procedure codes to service categories and code descriptions, identifies which managed-by entity reviews requests, and specifies effective dates for prior authorization implementation. It also clarifies PA submission paths and oncology diagnosis support requirements.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/2025-commercial-outpatient-specialty-pharmacy-prior-authorization-codes-effective-112025/288905/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/2025-commercial-outpatient-specialty-pharmacy-prior-authorization-codes-effective-112025/288905.png","ImageObject",442,249,{"name":88,"@type":89},"Skyler","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-12","2026-09-17",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",9,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"How can users search the document for a specific procedure code or description?","Question",{"text":109,"@type":110},"The PDF is searchable. Use CTRL+F to open the search box, then enter a procedure code or service description.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"Which organization manages prior authorization requests for provider-administered therapy or infusion site-of-care?",{"text":114,"@type":110},"Send PA requests to BCBSIL for provider-administered therapy or infusion site of care. For medical oncology and supportive care, send requests to Carelon, with review limited to oncology diagnosis–supported requests.",{"name":116,"@type":107,"acceptedAnswer":117},"What does the procedure code table include for each entry?",{"text":118,"@type":110},"Each row provides the procedure code, service category, code description, the managed-by entity (Carelon or BCBSIL), and update notes including effective dates when prior authorization was implemented.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},288905,1791014753,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":40,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":141},2336464648746,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","2025 Commercial Outpatient Specialty Pharmacy Prior Authorization Codes Effective 1/1/2025  \n(Updated April 2025)  \n\n| The list below includes Specialty Pharmacy (infusion site-ofcare or provider administered drug therapies, including cellular immunotherapy, gene therapy and other medical benefit drug therapies) for which benefit prior authorization through Blue Cross and Blue Shield of Illinois (BCBSIL) may be required prior to administration of these drugs for some of our commercial, non-HMO members.\u003Cbr>Use this document to view details for a procedure code, including: 1) Drug Product Name-Brand (generic); 2) Reason for prior authorization where medical necessity review is required for both therapy and place of infusion (Infusion Site of Care) or for therapy only (Provider Administered Drug Therapy)\u003Cbr>and/or for Medical Oncology & Supportive Care and 3) Effective date for when prior authorization was implemented at BCBSIL (provider administered drug therapy or infusion site of care) or Carelon Medical Benefits Management (requests for oncology drugs that are supported by an oncology diagnosis) . |  |  | Utilization Management Process\u003Cbr>This file is a searchable PDF. Press \"CTRL\" and \"F\" keys at the same time to bring up the search box. Enter a procedure code or description of the service. |  |\n| --- | --- | --- | --- | --- |\n| For Medical Policy information, please access the BCBSIL Medical Policy Website |  |  |  |  |\n| Carelon Medical Benefits Management = Med Oncology & Supportive Care BCBSIL = Provider Administered Therapy Or Infusion Site Of Care\u003Cbr>Send PA requests to BCBSIL for Provider Administered Therapy or Infusion Site of Care. Send PA requests to Carelon for Medical Oncology and Supportive care unless drug requested has multiple indications. Carelon will only review requests for oncology drugs that are supported by an oncology diagnosis. Refer to the Update\u003Cbr>History / Prior Authorization Delegation Notes for details. |  |  |  |  |\n| Procedure Code | Service Category | Code Description | Managed By | Updates |\n| J1552 | Infusion Site of Care, Medical Oncology & Supportive Care, Provider Administered Drug Therapy | Injection, immune globulin (alyglo), 500 mg | Carelon or BCBSIL | Add Effective 04/01/2025 . Add to Infusion Site of Care category 07/01/2025 . |\n| J1576 | Infusion Site of Care, Medical Oncology & Supportive Care, Provider Administered Drug Therapy | Injection Immune Globulin (Panzyga) Intravenous NonLyophilized (E. G. Liquid) 500 Mg | Carelon or BCBSIL | Add to Provider Administered Drug Therapy 01/01/25 . Add to Infusion Site of Care category 07/01/2025 . Carelon will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBS. |\n| J1599 | Infusion Site of Care, Medical Oncology & Supportive Care, Provider Administered Drug Therapy | Injection Immune Globulin Intravenous Non-Lyophilized (E. G. Liquid) Not Otherwise Specified 500 Mg | Carelon or BCBSIL | Add to Infusion Site of Care category 07/01/2025 . Carelon will review requests for oncology drugs that are supported by an oncology diagnosis. If the drug requested is not associated with an oncology diagnosis, it will be reviewed by BCBS. |\n\nBlue Cross and Blue Shield of Illinois, a Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an  \nIndependent Licensee of the Blue Cross and Blue Shield Association  \n\n| 90283 | Infusion Site of Care, Provider Administered Drug Therapy | Immune Globulin (Igiv) Human For Intravenous Use | BCBSIL | Add to Infusion Site of Care category 07/01/2025 . |\n| --- | --- | --- | --- | --- |\n| 90284 | Infusion Site of Care, Provider Administered Drug Therapy | Immune Globulin (Scig) Human For Use In Subcutaneous Infusions 100 Mg Each | BCBSIL | Add to Infusion Site of Care category 07/01/2025 . |\n| J1299 | Infusion Site of Care, Provider Administered Drug Therapy | Injection, ecul","cbCaipTCEbtGbV3O","https://ap.wps.com/l/cbCaipTCEbtGbV3O","pdf",320042,"English","# Utilization Management Process\n## Search instructions and procedure code lookup\n# Managed By and Prior Authorization Delegation Notes\n## BCBSIL vs Carelon review responsibilities\n# Procedure Code Table (2025)","[{\"question\":\"How can users search the document for a specific procedure code or description?\",\"answer\":\"The PDF is searchable. Use CTRL+F to open the search box, then enter a procedure code or service description.\"},{\"question\":\"Which organization manages prior authorization requests for provider-administered therapy or infusion site-of-care?\",\"answer\":\"Send PA requests to BCBSIL for provider-administered therapy or infusion site of care. For medical oncology and supportive care, send requests to Carelon, with review limited to oncology diagnosis–supported requests.\"},{\"question\":\"What does the procedure code table include for each entry?\",\"answer\":\"Each row provides the procedure code, service category, code description, the managed-by entity (Carelon or BCBSIL), and update notes including effective dates when prior authorization was implemented.\"}]","2025 Commercial Outpatient Specialty Pharmacy Prior Authorization Codes - Effective 1/1/2025 | PDF",1789634194,6]