Prior authorization requirements for subcutaneous implantable defibrillator system
Effective February 1, 2019, prior authorization (PA) requirements will change for the Subcutaneous Implantable Defibrillator system to be covered by Anthem Blue Cross. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
PA requirements will be added to the following:
- Subcutaneous Implantable Defibrillator system — Insertion or replacement of permanent subcutaneous implantable defibrillator system, with subcutaneous electrode, including defibrillation threshold evaluation (33270)
To request PA, you may use one of the following methods:
- Web: https://www.availity.com
- Fax: 1-800-754-4708
- o 1-888-831-2246 (Medi-Cal)
- o 1-877-273-4193 (Medi-Cal Access Program and Major Risk Medical Insurance Program)
Not all PA requirements are listed here. PA requirements are available to contracted providers through the Availity Portal (https://www.availity.com). Providers who are unable to access Availity may call us for PA requirements at 1-888-831-2246 (Medi-Cal) or 1-877-273-4193 (Medi-Cal Access Program and Major Risk Medical Insurance Program).
December 2018 Anthem Blue Cross Provider Newsletter - California