Policy Updates Prior AuthorizationMedicaidApril 4, 2025

Precertification/prior authorization requirement changes

Effective August 1, 2025, precertification/prior authorization requirements will change for the following code(s). The medical code(s) listed below will require precertification/prior authorization by Anthem for Medi‑Cal Managed Care members. 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 precertification/prior authorization rules and must be considered first when determining coverage. 

If the requirements are not met, those services may be deemed ineligible for payment. Providers may appeal online through Availity Essentials or by calling 800‑407‑4627 (TTY 711) outside L.A. County or 888‑285‑7801 (TTY 711) inside L.A. County with additional information that may include medical records.

Precertification/prior authorization requirements will be added for the following code(s):

Code

Description

61624

Transcatheter Perm Occlusion/Embolization, Percutaneous; Cns

82542

Column Chromatography/Mass Spectrometry; Quantitative, Single Stationary & Mobile Phase

83921

Organic Acid, Single, Quantitative

A4543

Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month

A7021

Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (Such as, handset, nebulizer kit, biofilter)

E0721

Transcutaneous electrical nerve stimulatory, stimulates nerves in the auricular region

E0738

Upper extremity rehabilitation system providing active assistance to facilitate muscle re-education, includes microprocessor, all components and accessories

E0743

External lower extremity nerve stimulator for restless legs syndrome, each

J9248

Injection, melphalan (Hepzato), 1 mg

L5783

Addition to lower extremity, user adjustable, mechanical, residual limb volume management system

L5841

Addition, endoskeletal knee-shin system, polycentric, pneumatic swing, and stance phase control

To request precertification/prior authorization, use one of the following methods:

  • Web: via Availity Essentials at https://Availity.com
  • Fax: 800‑754‑4708
  • Phone:
    • Medi‑Cal: 888‑831‑2246
    • MRMIP: 877‑273‑4193

Not all precertification/prior authorization requirements are listed here. Detailed precertification/prior authorization requirements are available to providers on https://providers.anthem.com/ca on the Resources tab or for contracted providers by accessing https://Availity.com. Providers may also call one of our Customer Care Centers for assistance with precertification/prior authorization requirements:

  • Outside Los Angeles County: 800‑407‑4627
  • Inside Los Angeles County: 888‑285‑7801

UM AROW A2025M2959

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Blue Cross of California is contracted with L.A. Care Health Plan to provide Medi-Cal Managed Care services in Los Angeles County. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

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PUBLICATIONS: May 2025 Provider Newsletter