Material adverse change

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

 

To obtain precertification, providers can access Availity* at www.availity.com or call the 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.

 

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.

 

Criteria

Criteria description

Codes

Effective date

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

44715

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

44720

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

44721

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

47143

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

47144

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

47145

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

47146

April 1, 2023

TRANS.00013

Small Bowel, Small Bowel/Liver and Multivisceral Transplantation

47147

April 1, 2023

CG-ANC-04

Ambulance Services: Air and Water

A0888

April 1, 2023

SURG.00036

Fetal Surgery for Prenatally Diagnosed Malformations

S2400

April 1, 2023

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.
GABCBS-CM-012056-22



Featured In:
January 2023 Anthem Provider News - Georgia