AIM Specialty Health® (AIM) currently performs utilization management review for bi-level positive airway pressure (BiPAP) equipment and all associated supplies. Beginning July 1, 2020, the following codes will require prior authorization with Anthem rather than with AIM.

 

Lines of business:  Individual Medicare Advantage, Group Retiree Solutions, and Medicare-Medicaid Plans

E0470

Respiratory assist device, bi-level pressure capability, without back-up rate feature, used with noninvasive interface, such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

E0471

Respiratory assist device, bi-level pressure capability, with back-up rate feature, used with noninvasive interface, such as a nasal or facial mask (intermittent assist device with continuous positive airway pressure device)

 

AIM will continue to manage the supply codes for automatic positive airway pressure (APAP) and continuous positive airway pressure (CPAP) requests.

 

We will continue to follow the COVID-19 Public Health Emergency orders from CMS until the waivers no longer apply. If the Public Health Emergency Orders are no longer in place beginning July 1, 2020, the following codes will require prior authorization with Anthem rather than with AIM when used in combination with the BiPAP codes above.

 

Precertification requests

Submit precertification requests via:

  • Fax: 866-959-1537
  • Phone: Please dial the customer service number on the back of the member’s card, identify yourself as a provider and follow the prompts to reach the correct precertification team. There are multiple prompts; select the prompt that fits the description for the authorization you plan to request.
  • Web: Use the Availity Web Tool by following this link: https://apps.availity.com/availity/web/public.elegant.login

 

A4604

Tubing with heating element

A7046

Water chamber for humidifier, replacement, each

A7027

Combination Oral/Nasal Mask used with positive airway pressure device, each

A7030

Full Face Mask used with positive airway pressure device, each

A7031

Face Mask Cushion, Replacement for Full Face Mask

A7034

Nasal Interface (mask or cannula type), used with positive airway pressure device, with/without head strap

A7035

Headgear

A7036

Chinstrap

A7037

Tubing

A7039

Filter, non-disposable

A7044

Oral Interface for Positive Airway Pressure Therapy

A7045

Replacement Exhalation Port for PAP Therapy

A7028

Oral Cushion, Replacement for Combination Oral/Nasal Mask, each

A7029

Nasal Pillows, Replacement for Combination Oral/Nasal Mask, pair

A7032

Replacement Cushion for Nasal Application Device

A7033

Replacement Pillows for Nasal Application Device, pair

A7038

Filter, disposable

 

ABSCARE-0535-20



Featured In:
July 2020 Anthem Connecticut Provider News