CommercialOctober 31, 2023
Precertification list change notification (MAC)
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 |
SURG.00007 | Vagus Nerve Stimulation | 2/1/2024 |
SURG.00010 | Treatments for Urinary Incontinence | 2/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | 2/1/2024 |
SURG.00079 | Nasal Valve Repair | 2/1/2024 |
SURG.00107 | Prostate Saturation Biopsy | 2/1/2024 |
SURG.00113 | Artificial Retinal Devices | 2/1/2024 |
SURG.00114 | Facet Joint Allograft Implants for Facet Disease | 2/1/2024 |
SURG.00124 | Carotid Sinus Baroreceptor Stimulation Devices | 2/1/2024 |
SURG.00132 | Drug-Eluting Devices for Maintaining Sinus Ostial Patency | 2/1/2024 |
SURG.00135 | Radiofrequency Ablation of the Renal Sympathetic Nerves | 2/1/2024 |
SURG.00156 | Implanted Artificial Iris Devices | 2/1/2024 |
SURG.00157 | Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis | 2/1/2024 |
SURG.00159 | Focal Laser Ablation for the Treatment of Prostate Cancer | 2/1/2024 |
SURG.00160 | Implanted Port Delivery Systems to Treat Ocular Disease | 2/1/2024 |
THER-RAD.00008 | Neutron Beam Radiotherapy | 2/1/2024 |
GABCBS-CM-041052-23
PUBLICATIONS: November 2023 Provider Newsletter
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