CommercialNovember 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 |
LAB.00042 | Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy | 0456U | 2/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer’s Disease | 0459U | 2/1/2025 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis | 0468U | 2/1/2025 |
TRANS.00039 | Portable Normothermic Organ Perfusion Systems | 0894T | 2/1/2025 |
TRANS.00039 | Portable Normothermic Organ Perfusion Systems | 0895T | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0687 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0688 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0689 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0744 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2183 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2184 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2281 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4311 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4312 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4313 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4314 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4315 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4316 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4317 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4318 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4319 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4320 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4321 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4322 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4323 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4324 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4325 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4326 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4327 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4328 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4329 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4330 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4331 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4332 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4333 | 2/1/2025 |
UM AROW A2024M2180
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-068611-24
PUBLICATIONS: November 2024 Provider Newsletter
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