Policy Updates Prior AuthorizationCommercialDecember 1, 2023

Precertification list change notification

The following services will be added to precertification for the effective dates listed below.

Eligibility and benefits can be verified by accessing Availity.com or by calling the number on the back of the member’s identification card. Service precertification 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 precertification prior to rendering the designated services listed below may result in denial of reimbursement.

Criteria added to precertification

Criteria

Criteria description

Effective date

MED.00011

Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State

3/1/2024

MED.00024

Adoptive Immunotherapy and Cellular Therapy

3/1/2024

MED.00082

Quantitative Sensory Testing

3/1/2024

MED.00092

Automated Nerve Conduction Testing

3/1/2024

MED.00096

Low-Frequency Ultrasound Therapy for Wound Management

3/1/2024

MED.00098

Hyperoxemic Reperfusion Therapy

3/1/2024

MED.00103

Automated Evacuation of Meibomian Gland

3/1/2024

MED.00105

Bioimpedance Spectroscopy Devices for the Detection and Management of Lymphedema

3/1/2024

MED.00111

Intracardiac Ischemia Monitoring

3/1/2024

MED.00131

Electronic Home Visual Field Monitoring

3/1/2024

MED.00134

Non-invasive Heart Failure and Arrhythmia Management and Monitoring System

3/1/2024

MED.00137

Eye Movement Analysis Using Non-spatial Calibration for the Diagnosis of Concussion

3/1/2024

MED.00141

High-volume Colonic Irrigation

3/1/2024

RAD.00053

Cervical and Thoracic Discography

3/1/2024

Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

GABCBS-CM-044086-23

PUBLICATIONS: December 2023 Provider Newsletter