Policy Updates Prior AuthorizationCommercialOctober 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