Policy Updates Prior AuthorizationMedicare AdvantageOctober 31, 2023

Prior authorization requirement changes effective March 1, 2024 

Effective March 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem Blue Cross for Medicare 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 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

33275

Transcatheter removal of permanent leadless pacemaker, right ventricular

33274

Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (such as fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (such as interrogation or programming), when performed

Not all PA requirements are listed here. Detailed PA requirements are available to providers on the provider website on the Claims tab or for contracted providers by accessing Availity.com. Providers may also call number on the back of their patient’s member ID card for Provider Services for assistance with PA requirements.

UM AROW 4290

Anthem BC Health Insurance Company is the trade name of Anthem Insurance Companies, Inc. Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross, Anthem Blue Cross Life and Health Insurance Company, and Anthem BC Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

CABC-CR-042747-23-CPN41430

PUBLICATIONS: December 2023 Provider Newsletter