Policy Updates Prior AuthorizationCommercialJuly 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 Essentials 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.

Add to precertification

Criteria

Criteria description

Code

Effective date

LAB.00027

Selected Blood, Serum and Cellular Allergy and Toxicity Tests

86001

10/1/2024

SURG.00010

Treatments for Urinary Incontinence

51715

10/1/2024

SURG.00010

Treatments for Urinary Incontinence

53446

10/1/2024

SURG.00010

Treatments for Urinary Incontinence

53448

10/1/2024

SURG.00010

Treatments for Urinary Incontinence

53449

10/1/2024

SURG.00010

Treatments for Urinary Incontinence

C1815

10/1/2024

SURG.00011

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

Q4102

10/1/2024

SURG.00011

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

Q4104

10/1/2024

SURG.00011

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

Q4106

10/1/2024

SURG.00011

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

Q4107

10/1/2024

SURG.00011

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

Q4110

10/1/2024

SURG.00011

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

Q4115

10/1/2024

SURG.00011

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

Q4121

10/1/2024

SURG.00011

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

Q4124

10/1/2024

SURG.00011

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

Q4133

10/1/2024

SURG.00011

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

Q4136

10/1/2024

SURG.00011

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

Q4186

10/1/2024

SURG.00011

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

Q4187

10/1/2024

SURG.00019

Transmyocardial Revascularization

33140

10/1/2024

SURG.00077

Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques

58674

10/1/2024

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-057780-24

PUBLICATIONS: July 2024 Provider Newsletter