AZ Blue Best Life Classic (HMO): Outpatient Diagnostic Tests and Therapeutic Services and Supplies
Includes therapeutic radiology services, diagnostic radiology services, diagnostic procedures and tests, surgical and splinting supplies, and lab services.
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How To Receive
Details on how to apply
Obtain a provider order for specific diagnostic testing.
Contact the AZ Blue Best Life Classic Team at 1-800-446-8331 (TTY 711) for prior authorization.
The prescribing provider may help with authorization.
Pain Management Assessment (evaluation and management only): $5 copay
Pain Management Treatment (e.g., epidurals, pain blockers, and injections): $75 copay per treatment
Radiation Therapy: $0 PCP Office. $50 copay all other settings
Electrocardiogram (EKG): $0 copay
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Covered services include, but are not limited to:
X-rays
Radiation (radium and isotope) therapy, including technician materials and supplies
Surgical supplies, such as dressings
Splints, casts, and other devices used to reduce fractures and dislocations
Laboratory tests
Blood - including storage and administration*
Other outpatient diagnostic tests
*Coverage of whole blood and packed red cells begins only with the fourth pint of blood needed—costs for the first 3 pints of blood in a calendar year must be paid out-of-pocket or the blood must be donated from self or by someone else. All other components of blood are covered beginning with the first pint.
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