Blue Cross PPO Prior Authorization

• PPO members require prior authorization for inpatient surgery, outpatient surgery over $1,500, and advanced imaging tied to surgical planning.
• Knee surgery consults do not require prior authorization by themselves.
• MRI or CT imaging ordered after the consult may require prior authorization if performed at a hospital outpatient department.
• If referral status is pending, route to auth review before scheduling imaging.
• Required fields: member ID, date of birth, ordering provider, CPT code, diagnosis code.