State & FederalMedicare AdvantageJanuary 31, 2023

Anthem Blue Cross expands specialty pharmacy precertification list

Effective for dates of service on and after February 1, 2023, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS or CPT® codes

Medicare Part B drugs

C9399, J3490, J3590

Spevigo (spesolimab-sbzo)

C9399, J3490, J3590

Xenpozyme (olipudase alfa)

CABC-CRMMP-008576-22-CPN8058

PUBLICATIONS: February 2023 Anthem Blue Cross Provider News - California