Policy UpdatesCommercialJanuary 1, 2021

Anthem Georgia preapproval list change notification 1/1/2021

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 preapproval

GENE.00055

Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity

0203U , 81479, 81599

Added 4/1/2021

LAB.00037

Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS)

0164U, 0176U

Added 4/1/2021

SURG.00158

Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

64555, 64575, 64590, C1767, C1778, C1787, L8679, L8680, L8683

Added 4/1/2021

 

 

Codes added to existing preapproval documents

CG-GENE-04

Molecular Marker Evaluation of Thyroid Nodules

0208U, 0204U, 81546

Added 0208U, 0204U 4/1/2021

Added 81546 1/1/2021, New Code

CG-GENE-18

Genetic Testing for TP53 Mutations

81351, 81352, 81353

Added 1/1/2021, New Codes

CG-MED-23

Home Health

G0068, G0069, G0070, G0088, G0089, G0090

Added 1/1/2021, New Codes

GENE.00052

Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling

81419, 0237U, 0238U

Added 1/1/2021, New Codes

SURG.00011

Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting

0627T, 0628T, 0629T, 0630T

Added 1/1/2021, New Codes

SURG.00145

Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)

33995

Added 1/1/2021, New Codes

CG-BEH-01

Assessment of Autism Spectrum Disorders and Rett Syndrome

33995

Added 1/1/2021, New Codes

CG-SURG-95

Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention

C1883

Added C1883 4/1/2021

GENE.00003

Genetic Testing and Biochemical Markers for the Diagnosis of Alzheimer's Disease

0206U, 0207U

Added 0206U, 0207U 4/1/2021

GENE.00049

Circulating Tumor DNA Testing for Cancer (Liquid Biopsy)

0229U, 0239U

Added 1/1/2021, New Codes

CG-GENE-01

Janus Kinase 2, CALR and MPL Gene Mutation Assays

81279, 81338, 81339

Added 1/1/2021, New Codes

CG-GENE-08

Genetic Testing for PTEN Hamartoma Tumor Syndrome

0235U

Added 1/1/2021, New Codes

CG-GENE-13

Genetic Testing for Inherited Diseases

0230U, 0231U, 0232U, 0233U, 0234U, 0236U

Added 1/1/2021, New Codes

CG-SURG-87

Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring

30468

Added 1/1/2021, New Codes

GENE.00023

Gene Expression Profiling of Melanomas

81529

Added 1/1/2021, New Codes

SURG.00151

Balloon Dilation of Eustachian Tubes

69705, 69706

Added 1/1/2021, New Codes

CG-GENE-14

81191, 81192, 81193, 81194

Added 1/1/2021, New Codes

 


918-0121-PN-GA

PUBLICATIONS: January 2021 Anthem Provider News - Georgia