Does Blue Care Network require prior authorization for CPT G0402?

Status not confirmed in our dataset. Confirm against the current Blue Care Network clinical policy before submitting.

What documentation does Blue Care Network require for CPT G0402?

Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.

How much does Medicare pay for CPT G0402 in 2026?

In 2026, the national Medicare allowable for CPT G0402 is $174.69 in an office setting and $114.23 in a facility. Commercial allowables for Blue Care Network are typically negotiated against this benchmark.

What if Blue Care Network denies the PA for CPT G0402?

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.

Prior Authorization

Blue Care Network Prior Authorization for CPT G0402

Initial preventive exam · Standard commercial plans

Status not confirmed

Source

Data pending source-document linkage. Verify against Blue Care Network's current clinical policy before submission.

Not 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.

We don't have a source-backed prior-authorization verdict for CPT G0402 with Blue Care Network under Standard commercial plans yet — confirm directly with the payer. The 2026 Medicare reference rate for this code is below, and you can draft the request free in Ask D3.

2026 Medicare rate for CPT G0402

Office (non-facility)

$174.69

Facility

$114.23

Total RVUs (office)

5.23

Conversion factor

$33.4009

National Medicare Physician Fee Schedule amounts (GPCI 1.0). Blue Care Network's commercial allowable is negotiated against this benchmark — see the full RVU and locality breakdown on the CPT G0402 code page.

How to submit the PA

1Verify the requirement against the current clinical policy linked above.
2Gather patient history, prior conservative treatment, and clinical justification.
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 Care Network require prior authorization for CPT G0402?: Status not confirmed in our dataset. Confirm against the current Blue Care Network clinical policy before submitting.
What documentation does Blue Care Network require for CPT G0402?: Documentation requirements vary by case. Standard items include clinical notes, imaging or test results, history of conservative treatment, and a clear statement of medical necessity.
How much does Medicare pay for CPT G0402 in 2026?: In 2026, the national Medicare allowable for CPT G0402 is $174.69 in an office setting and $114.23 in a facility. Commercial allowables for Blue Care Network are typically negotiated against this benchmark.
What if Blue Care Network denies the PA for CPT G0402?: 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 Care Network PA lookups

CPT J0897 CPT J1745 CPT G2211 CPT J3301 CPT J0585 CPT G0439 CPT G0438 CPT J1885

All Blue Care Network prior-authorization requirements →

CPT G0402 prior authorization by payer

Blue Cross Blue Shield Cigna Aetna Humana TRICARE Medicare

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