CommercialMarch 1, 2024
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 | Criteria description | Code | Effective date |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L7510 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L7520 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | K1014 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5856 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5857 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5858 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5859 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5969 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5973 | June 1, 2024 |
CG-OR-PR-09 | Microprocessor Controlled Knee-Ankle-Foot Orthosis | L2006 | June 1, 2024 |
CG-SURG-61 | Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver | 53850 | June 1, 2024 |
CG-SURG-61 | Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver | 53852 | June 1, 2024 |
CG-SURG-61 | Cryosurgical, Radiofrequency, Microwave or Laser Ablation to Treat Solid Tumors Outside the Liver | C9751 | June 1, 2024 |
CG-SURG-78 | Locoregional Techniques for Treating Primary and Metastatic Liver Malignancies | C9790 | June 1, 2024 |
CG-SURG-79 | Implantable Infusion Pumps | E0786 | June 1, 2024 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0769 | June 1, 2024 |
DME.00041 | Ultrasonic Diathermy Devices | K1036 | June 1, 2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0490 | June 1, 2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0491 | June 1, 2024 |
Carelon Medical Benefits Management, Inc. Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0403U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0411U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0419U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0262U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0405U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0409U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0410U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0413U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0414U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0415U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0417U | June 1, 2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0342U | June 1, 2024 |
LAB.00028 | Blood-based Biomarker Tests for Multiple Sclerosis | 0361U | June 1, 2024 |
LAB.00040 | Serum Biomarker Tests for Risk of Preeclampsia | 0390U | June 1, 2024 |
LAB.00041 | Machine Learning Derived Probability Score for Rapid Kidney Function Decline | 0407U | June 1, 2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer’s Disease | 0412U | June 1, 2024 |
MED.00143 | Ingestible Devices for the Treatment of Constipation | A9268 | June 1, 2024 |
MED.00143 | Ingestible Devices for the Treatment of Constipation | A9269 | June 1, 2024 |
MED.00145 | Digital Therapy Devices for Treatment of Amblyopia | A9292 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2022 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2023 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2024 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2025 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | C1832 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4285 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4286 | June 1, 2024 |
SURG.00026 | Deep Brain, Cortical, and Cerebellar Stimulation | C1787 | June 1, 2024 |
SURG.00071 | Percutaneous and Endoscopic Spinal Surgery | C2614 | June 1, 2024 |
SURG.00144 | Occipital and Sphenopalatine Ganglion Nerve Block Therapy for the Treatment of Headache and Neuralgia | 64505 | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0494T | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0495T | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0496T | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefits Management Genetic Testing Guideline | 0088U | June 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-049256-24-SRS49256
PUBLICATIONS: March 2024 Provider Newsletter
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