CommercialNovember 1, 2024
Precertification List Change Notification — November 1, 2024
The following services will be added to precertification for the effective dates listed below.
To obtain precertification, providers can access Availity @ www.availity.com or call Anthem’s Utilization Management department using the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved.
Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member's care is medically necessary and administered at an appropriate network facility and by a network provider.
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 Anthem Health Plans, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-067491-24
PUBLICATIONS: November 2024 Provider Newsletter
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