Does Blue Care Network require prior authorization for CPT J1745?

Yes. Blue Care Network requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.

What documentation does Blue Care Network require for CPT J1745?

Member benefit and eligibility verification; Clinical records supporting the requested service when requested by BCBSM/BCN or its delegated vendor

What if Blue Care Network denies the PA for CPT J1745?

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 J1745

Infliximab - infliximab · Standard commercial plans

Prior authorization REQUIREDState-specific policyLast verified May 9, 2026 · Reviewed by the D3rx Clinical Billing Team

Source

Blue Care Network Procedure Codes Requiring Prior Authorization

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.

Clinical criteria

Blue Care Network public procedure-code table lists J1745 as requiring prior authorization for HMO BCN commercial members, managed by Blue Cross Medical and Pharmacy Drug, table date May 1, 2026. Effective date text in the table: 4/21/2025. 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 J1745

CPT J1745 is not priced under the 2026 Medicare Physician Fee Schedule (status E) — drugs/biologicals price under ASP and lab tests under the CLFS. See the CPT J1745 code page for pricing detail.

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 Care Network require prior authorization for CPT J1745?: Yes. Blue Care Network requires prior authorization for CPT J1745 (Infliximab - infliximab) under Standard commercial plans per its published clinical policy.
What documentation does Blue Care Network require for CPT J1745?: Member benefit and eligibility verification; Clinical records supporting the requested service when requested by BCBSM/BCN or its delegated vendor
What if Blue Care Network denies the PA for CPT J1745?: 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 G2211 CPT J3301 CPT J0585 CPT G0402 CPT G0439 CPT G0438 CPT J1885

All Blue Care Network prior-authorization requirements →

CPT J1745 prior authorization by payer

Blue Cross Blue Shield Cigna Aetna Humana TRICARE Medicare

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