CommercialPrior AuthMedium impact
DME Prior Authorization Updates
CareFirst BlueCross BlueShield·Orthopedics, PM&R (Physical Medicine & Rehab), Neurology·Prior Authorization
Effective date
Jun 1, 2023
We identified it
Jun 20, 2026
Summary
CareFirst BlueCross BlueShield is requiring prior authorization for three specific high-cost durable medical equipment codes for BlueChoice HMO members starting June 1, 2023. These codes cover advanced prosthetic devices including knee-ankle-foot devices and powered upper extremity assist devices.
Action Required
By June 1, 2023: Billing team must update system to require prior authorization for HCPCS codes L2006, L8701, and L8702 for all CareFirst BlueChoice HMO members. Update encounter forms and DME order processes to remind providers to obtain prior auth before ordering these devices. Access CareFirst's Pre-Cert/Pre-Auth page and complete on-demand training in their Learning and Engagement Center. Claims will be denied without proper prior authorization.