Prior Authorization
Blue Cross Blue Shield of Michigan Prior Authorization for CPT 71250
CT of thorax diagnostic and CT angiography of chest (noncoronary) with various contrast protocols · Standard commercial plans
Source
Blue Cross Blue Shield of Michigan Procedure Codes Requiring Prior AuthorizationNot medical advice. PA policies change frequently. Always confirm against the payer's current policy before submitting. d3rx pulls directly from publicly published policy PDFs and refreshes daily.
Clinical criteria
Blue Cross Blue Shield of Michigan public procedure-code table lists 71250 as requiring prior authorization for PPO/PPO* Blue Cross commercial members, managed by Carelon, table date May 1, 2026. Verify the member, group, benefits, and submission path in Availity or the payer portal; this listing is not a payment or medical-necessity approval guarantee.
Documentation checklist
- ✓Member benefit and eligibility verification
- ✓Clinical records supporting the requested service when requested by BCBSM/BCN or its delegated vendor
2026 Medicare rate for CPT 71250
Office (non-facility)
$132.60
Facility
$132.60
Total RVUs (office)
3.97
Conversion factor
$33.4009
National Medicare Physician Fee Schedule amounts (GPCI 1.0). Blue Cross Blue Shield of Michigan's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT 71250 code page.
How to submit the PA
- 1Verify the requirement against the current clinical policy linked above.
- 2Gather documentation: Member benefit and eligibility verification, Clinical records supporting the requested service when requested by BCBSM/BCN or its delegated vendor.
- 3Submit via the payer's provider portal or designated PA channel.
- 4Document the reference number and follow up within 5 business days if no determination is received.
FAQ
- Does Blue Cross Blue Shield of Michigan require prior authorization for CPT 71250?
- Yes. Blue Cross Blue Shield of Michigan requires prior authorization for CPT 71250 (CT of thorax diagnostic and CT angiography of chest (noncoronary) with various contrast protocols) under Standard commercial plans per its published clinical policy.
- What documentation does Blue Cross Blue Shield of Michigan require for CPT 71250?
- Member benefit and eligibility verification; Clinical records supporting the requested service when requested by BCBSM/BCN or its delegated vendor
- How much does Medicare pay for CPT 71250 in 2026?
- In 2026, the national Medicare allowable for CPT 71250 is $132.60 in an office setting and $132.60 in a facility. Commercial allowables for Blue Cross Blue Shield of Michigan are typically negotiated against this benchmark.
- What if Blue Cross Blue Shield of Michigan denies the PA for CPT 71250?
- Appeal in writing within 60 days, citing the specific clinical policy criteria the case meets and attaching supporting documentation. Many denials are reversed on first-level appeal when the criteria language is mirrored.
Other Blue Cross Blue Shield of Michigan PA lookups
CPT 71250 prior authorization by payer
Draft the Blue Cross Blue Shield of Michigan PA request for CPT 71250 — free
Ask D3 builds a payer-ready prior-authorization request with the right criteria language and documentation — backed by CMS, Medicare, and major-payer data. No signup.