Material adverse change

Effective for dates of service on and after June 1, 2023, the following code updates will apply to the Carelon Medical Benefits Management, Inc. Radiology Clinical Appropriateness Guidelines.


Advanced imaging of the abdomen and pelvis

CPT®

 code

Description

0648T

Quantitative magnetic resonance for analysis of tissue composition (for example, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation, and report, obtained without diagnostic MRI examination of the same anatomy (for example, organ, gland, tissue, target structure) during the same session.

 

Oncologic imaging

CPT code

Description

0633T

CT Breast W/3d Rendering Uni without contrast

0634T

CT Breast W/3d Rendering Uni with contrast

0635T

CT Breast W/3d Rendering Uni with or without contrast

0636T

CT Breast W/3d Rendering Bi without contrast

0637T

CT Breast W/3d Rendering Bi with contrast

0638T

CT Breast W/3d Rendering Bi with or without contrast


As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon in one of several ways:

  • Access the ProviderPortalSM directly at providerportal.com.
    • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
  • Access the Availity* website at availity.com.

 

If you have questions related to guidelines, please email MedicalBenefitsManagement.guidelines@carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Carelon Medical Benefits Management, Inc. is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.
GABCBS-CM-13584-22-CPN12763



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March 2023 Anthem Provider News - Georgia