AdministrativeCommercialSeptember 30, 2022

Preapproval list change notification October 1, 2022 (MAC)

Material adverse change

 

The following services will be added to prior authorization for GA local members for the effective dates listed below.

 

Eligibility and benefits can be verified by accessing Availity* via the Anthem Blue Cross and Blue Shield (Anthem) provider website or by calling the number on the back of the member’s identification card. Service preapproval is based on the 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 approval prior to rendering the designated services listed below may result in denial of reimbursement.

 

Add to preapproval

Criteria

Criteria description

Code

Effective date

SURG.00120

Internal rib fixation systems

21811

Add 01/01/2023

SURG.00120

Internal rib fixation systems

21812

Add 01/01/2023

SURG.00120

Internal rib fixation systems

21813

Add 01/01/2023

SURG.00116

High resolution anoscopy screening for anal intraepithelial neoplasia (AIN) and squamous cell cancer of the anus

46601

Add 01/01/2023

SURG.00116

High resolution anoscopy screening for anal intraepithelial neoplasia (AIN) and squamous cell cancer of the anus

46607

Add 01/01/2023

TRANS.00011; TRANS.00013

Pancreas transplantation and pancreas kidney transplantation; small bowel, small bowel/liver and multivisceral transplantation

48551

Add 01/01/2023

TRANS.00011; TRANS.00013

Pancreas transplantation and pancreas kidney transplantation; small bowel, small bowel/liver and multivisceral transplantation

48552

Add 01/01/2023

TRANS.00011

Pancreas transplantation and pancreas kidney transplantation

48556

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

59076

Add 01/01/2023

SURG.00144

Occipital nerve block therapy for the treatment of headache and occipital neuralgia

64405

Add 01/01/2023

LAB.00027

Selected blood, serum and cellular allergy and toxicity tests

83516

Add 01/01/2023

CG-LAB-13

Skin nerve fiber density testing

88356

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

A0430

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

A0431

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

A0435

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

A0436

Add 01/01/2023

CG-DME-44

Electrical nerve stimulation, transcutaneous, percutaneous

A4555

Add 01/01/2023

RAD.00064

Myocardial sympathetic innervation imaging with or without single-photon emission computed tomography (SPECT)

A9582

Add 01/01/2023

RAD.00036

MRI of the breast

C8903

Add 01/01/2023

RAD.00036

MRI of the breast

C8905

Add 01/01/2023

RAD.00036

MRI of the breast

C8906

Add 01/01/2023

RAD.00036

MRI of the breast

C8908

Add 01/01/2023

DME.00037

Cooling devices and combined cooling/heating devices

E0217

Add 01/01/2023

CG-DME-44

Electrical nerve stimulation, transcutaneous, percutaneous

E0766

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2401

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2402

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2403

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2404

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2405

Add 01/01/2023

SURG.00036

Fetal surgery for prenatally diagnosed malformations

S2409

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

S9960

Add 01/01/2023

CG-ANC-04

Ambulance services: air and water

S9961

Add 01/01/2023

 

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

GABCBS-CM-006238-22

PUBLICATIONS: October 2022 Anthem Provider News - Georgia