Anthem Georgia preapproval list change notification 11/1/2020

AIM Speciality Health®

AIM Specialty Health, a separate company, is a nationally recognized leader delivering specialty benefits management on behalf of Anthem for certain health plan members. Determine if preapproval is needed for a Georgia Anthem member by visiting the “Medical Policy and Clinical UM Guidelines” page on our provider website or by calling the preapproval phone number printed on the back of the member’s ID card. To submit your request for any of the services below, contact AIM online via AIM’s ProviderPortal at aimspecialtyhealth.com/goweb. From the drop-down menu, select GA. You may also call AIM toll-free at 866-714-1103, Monday–Friday, 8:00 a.m.–6:00 p.m. ET

 

AIM provides benefits management for the programs listed below:

• Imaging Level of Care
• Genetic Testing
• Diagnostic Imaging Management
• Cardiovascular Services
• Radiation Therapy Services
• Outpatient Sleep Testing and Therapy Services
• Cancer Care Quality Program
• Musculoskeletal (for Fully Insured)
• Upper Gastrointestinal Endoscopy

For more details on these programs, please visit the AIM Specialty Health® site at aimspecialtyhealth.com/marketing/guidelines/185/index.html. By clicking on the previous links, you will be directed to sites created and/or maintained by another, separate entity (“External Site”). Upon linking you are subject to the terms of use, privacy, copyright and security policies of the External Sites. We provide these links solely for your information and convenience. We encourage you to review the privacy practices of the External Sites. The information contained on the External Sites should not be interpreted as medical advice or treatment provided by us.

 

Eligibility and benefits

Eligibility and benefits can be verified by through anthem.com/provider 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 preappoval
MED.00134 Non-invasive Heart Failure and Arrhythmia Management and Monitoring System	0607T, 0608T	Add 2/1/2021
SURG.00156 Implanted Artificial Iris Devices	0616T, 0617T, 0618T, C1839	Add 2/1/2021
SURG.00157 Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis	30999, 30117	Add 2/1/2021

Codes added to existing preapproval documents
MED.00103 Automated Evacuation of Meibomian Gland	0563T	Add 2/1/2021
SURG.00077 Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques   Previous title: Uterine Fibroid Ablation: Laparoscopic or Percutaneous Image Guided Techniques	0404T	Add 2/1/2021
SURG.00112 Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)   Previous title: Occipital Nerve and Supraorbital Nerve Stimulation	61885, 64568, 64569, C1767, C1778	Add 2/1/2021
SURG.00129 Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring	C1767, C1778, C1787, L8680, L8681, L8688	Add 2/1/2021
SURG.00011 Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting	Q4249, Q4250, Q4254, Q4255	Add 10/1/2020, New Code
OR-PR.00006 Powered Robotic Lower Body Exoskeleton Devices	K1007	Add 10/1/2020, New Code
GENE.00037 Genetic Testing for Macular Degeneration	0205U	Add 10/1/2020, New Code
CG-GENE-05 Genetic Testing for DMD Mutations (Duchenne or Becker Muscular Dystrophy)	0218U	Add 10/1/2020, New Code
CG-GENE-10 Chromosomal Microarray Analysis (CMA) for Developmental Delay, Autism Spectrum Disorder, Intellectual Disability (Intellectual Developmental Disorder) and Congenital Anomalies	0209U	Add 10/1/2020, New Code
GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling	0212U-0217U	Add 10/1/20-New Codes
CG-SURG-27 Gender Reassignment Surgery	54400, 54401, 54405, 55899, C1813, C2622, L8699	Add 9/01/2020

734-1120-PN-GA