Eligibility and benefits

Eligibility and benefits can be verified by accessing the Anthem Blue Cross and Blue Shield web site or by calling 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 preapproval prior to rendering the designated services listed below will result in denial of reimbursement.

 

   Add to preapproval       

 

MED.00129 Gene Therapy for Spinal Muscular Atrophy

J3490-Zolgensma

Add 12/1/19

SURG.00153 Cardiac Contractility Modulation Therapy

0408T, 0409T, 0410T, 0411T, 0412T, 0413T, 0414T, 0415T, 0416T, 0417T, 0418T

Add 12/1/12019

 

Codes added to existing preapproval documents

 

DME.00037 Cooling Devices and Combined Cooling/Heating Devices

E1399

Add 12/1/19

LAB.00033 Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer

81479

Add 12/1/19

SURG.00045 Extracorporeal Shock Wave Therapy

0512T, 0513T, 55899

Add 12/1/19

SURG.00121 Transcatheter Heart Valve Procedures

0544T, 0545T

Add 12/1/19

CG-DME-07 Augmentative and Alternative Communication (AAC) Devices with Digitized or Synthesized Speech Output

E2511, E2512, E2599

Add 12/1/2019



Featured In:
September 2019 Anthem Provider News - Georgia