CommercialJuly 1, 2024
Precertification list change notification July 1, 2024
The following services will be added to precertification for the effective dates listed below.
To obtain precertification, providers can access Availity (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 |
CG-DME-06 | Compression Devices for Lymphedema | E0678 | 10/1/2024 |
CG-DME-06 | Compression Devices for Lymphedema | E0679 | 10/1/2024 |
CG-DME-06 | Compression Devices for Lymphedema | E0680 | 10/1/2024 |
CG-DME-06 | Compression Devices for Lymphedema | E0681 | 10/1/2024 |
CG-DME-06 | Compression Devices for Lymphedema | E0682 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33276 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33277 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33278 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33279 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33280 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33281 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33287 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 33288 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 93150 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 93151 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 93152 | 10/1/2024 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | 93153 | 10/1/2024 |
CG-SURG-83 | Bariatric Surgery and Other Treatments for Clinically Severe Obesity | 0813T | 10/1/2024 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | A4540 | 10/1/2024 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0732 | 10/1/2024 |
DME.00042 | Electronic Positional Devices for the Treatment of Obstructive Sleep Apnea | E0530 | 10/1/2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0492 | 10/1/2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0493 | 10/1/2024 |
DME.00046 | Intermittent Abdominal Pressure Ventilation Devices | A4468 | 10/1/2024 |
DME.00049 | External Upper Limb Stimulation for the Treatment of Tremors | A4542 | 10/1/2024 |
DME.00049 | External Upper Limb Stimulation for the Treatment of Tremors | E0734 | 10/1/2024 |
GENE.00010 | Panel and other Multi-Gene Testing for Polymorphisms to Determine Drug-Metabolizer Status | 0423U | 10/1/2024 |
GENE.00010 | Panel and other Multi-Gene Testing for Polymorphisms to Determine Drug-Metabolizer Status | 0434U | 10/1/2024 |
GENE.00010 | Panel and other Multi-Gene Testing for Polymorphisms to Determine Drug-Metabolizer Status | 0438U | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81457 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81458 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81459 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81462 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81463 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81464 | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0422U | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0424U | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0425U | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0426U | 10/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0428U | 10/1/2024 |
GENE.00056 | Gene Expression Profiling for Bladder Cancer | 0420U | 10/1/2024 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0435U | 10/1/2024 |
LAB.00016 | Fecal Analysis in the Diagnosis of Intestinal Disorders | 0430U | 10/1/2024 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis | 81517 | 10/1/2024 |
LAB.00050 | Metagenomic Sequencing for Infectious Disease in the Outpatient Setting | 0112U | 10/1/2024 |
LAB.00050 | Metagenomic Sequencing for Infectious Disease in the Outpatient Setting | 0152U | 10/1/2024 |
LAB.00050 | Metagenomic Sequencing for Infectious Disease in the Outpatient Setting | 0323U | 10/1/2024 |
MED.00130 | Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring | E0746 | 10/1/2024 |
RAD.00068 | Myocardial Strain Imaging | C9762 | 10/1/2024 |
RAD.00068 | Myocardial Strain Imaging | C9763 | 10/1/2024 |
SURG.00007 | Vagus Nerve Stimulation | E0735 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4279 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4287 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4288 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4289 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4290 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4291 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4292 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4293 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4294 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4295 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4296 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4297 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4298 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4299 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4300 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4301 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4302 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4303 | 10/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4304 | 10/1/2024 |
SURG.00026 | Deep Brain, Cortical, and Cerebellar Stimulation | 61889 | 10/1/2024 |
SURG.00026 | Deep Brain, Cortical, and Cerebellar Stimulation | 61891 | 10/1/2024 |
SURG.00026 | Deep Brain, Cortical, and Cerebellar Stimulation | C1778 | 10/1/2024 |
SURG.00045 | Extracorporeal Shock Wave Therapy | 0864T | 10/1/2024 |
SURG.00077 | Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques | 58580 | 10/1/2024 |
SURG.00097 | Scoliosis Surgery | 22836 | 10/1/2024 |
SURG.00097 | Scoliosis Surgery | 22837 | 10/1/2024 |
SURG.00097 | Scoliosis Surgery | 22838 | 10/1/2024 |
SURG.00097 | Scoliosis Surgery | 0790T | 10/1/2024 |
SURG.00142 | Genicular Procedures for Treatment of Knee Pain | 37242 | 10/1/2024 |
SURG.00150 | Leadless Pacemaker | 0823T | 10/1/2024 |
SURG.00150 | Leadless Pacemaker | 0824T | 10/1/2024 |
SURG.00150 | Leadless Pacemaker | 0825T | 10/1/2024 |
SURG.00150 | Leadless Pacemaker | 0826T | 10/1/2024 |
SURG.00152 | Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing | 0861T | 10/1/2024 |
SURG.00152 | Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing | 0862T | 10/1/2024 |
SURG.00152 | Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing | 0863T | 10/1/2024 |
SURG.00157 | Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis | 31242 | 10/1/2024 |
SURG.00157 | Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis | 31243 | 10/1/2024 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | 64596 | 10/1/2024 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | 64597 | 10/1/2024 |
UM AROW# A2024M1436
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-058786-24-CPN57724
PUBLICATIONS: July 2024 Provider Newsletter
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