Policy Updates Prior AuthorizationMedicaidAugust 5, 2024

Prior authorization requirement changes

Effective December 1, 2024

Effective December 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA 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 PA rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Code

Description

33263

Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Dual Lead System

64582

Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array

C2616

Brachytherapy source, nonstranded, yttrium-90, per source when specified as yttrium-90 microspheres

To request PA, you may use one of the following methods:

  • Web: once logged in at Availity.com
  • Fax: 800-754-4708
  • Phone: 888-831-2246 — Medi-Cal, 877-273-4193 — MRMIP

Not all PA requirements are listed here. Detailed PA requirements are available to providers on providers.anthem.com/ca on the Resources tab or contracted providers can access Availity.com. Providers may also call Medi-Cal Customer Care Centers for assistance with PA requirements:

  • Outside L.A. County: 800-407-4627
  • L.A. County: 888-285-7801

UM AROW A2024M1414

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.

CABC-CD-059301-24-CPN58059

PUBLICATIONS: September 2024 Provider Newsletter