Policy Updates Prior AuthorizationCommercialNovember 1, 2024

Material adverse change

Precertification List Change Notification — November 1, 2024

The following services will be added to precertification for the effective dates listed below.

Eligibility and benefits can be verified by accessing Availity at Availity.com or by calling the number on the back of the member’s identification card. Service precertification is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits.

Except in the case of an emergency, failure to obtain precertification prior to rendering the designated services listed below may result in denial of reimbursement.

Add to precertification

Criteria

Criteria description

Code

Effective date

MED.00140

Gene Therapy for Beta Thalassemia

J3393

2/1/2025

MED.00146

Gene Therapy for Sickle Cell Disease

J3394

2/1/2025

Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-068177-24

PUBLICATIONS: November 2024 Provider Newsletter