Policy Updates Prior AuthorizationCommercialSeptember 1, 2023

Precertification list change notification effective December 1, 2023

This article has been updated to remove archived criteria CG-SURG-27. Please see updated article here.

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

To obtain precertification, providers can access Availity Essentials* (Availity.com) or call Anthem Blue Cross and Blue Shield’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

CG-SURG-27

Gender Affirming Surgery

15769

12/01/2023 

CG-SURG-27

Gender Affirming Surgery

53410

12/01/2023

CG-SURG-27

Gender Affirming Surgery

53420

12/01/2023

CG-SURG-27

Gender Affirming Surgery

53425

12/01/2023

CG-SURG-27

Gender Affirming Surgery

53430

12/01/2023

CG-SURG-27

Gender Affirming Surgery

54400

12/01/2023

CG-SURG-27

Gender Affirming Surgery

57426

12/01/2023

CG-SURG-27

Gender Affirming Surgery

58150

12/01/2023

CG-SURG-27

Gender Affirming Surgery

58571

12/01/2023

CG-SURG-27

Gender Affirming Surgery

58572

12/01/2023

CG-SURG-27

Gender Affirming Surgery

58573

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D7899

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9950

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9951

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9952

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

E0656

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

E0657

12/01/2023

CG-DME-45

Ultrasound Bone Growth Stimulation

E0760

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

K1024

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

K1025

12/01/2023

*Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

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.

CTBCBS-CM-033553-23-SRS33553

PUBLICATIONS: September 2023 Provider Newsletter