Policy Updates Prior AuthorizationMedicare AdvantageOctober 3, 2023

Prior authorization requirement changes effective February 1, 2024 - code J1411

Effective February 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem Blue Cross and Blue Shield for Medicare Advantage members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines (including definitions and specific contract provisions/exclusions), take precedence over these precertification rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Code

Description

J1411

Injection, etranacogene dezaparvovec-drlb, per therapeutic dose

Not all PA requirements are listed here. Detailed PA requirements are available to providers on https://www.anthem.com/medicareprovider on the Resources tab or for contracted providers by accessing Availity.com.* Providers may also call Provider Services at the number on the back of the patient’s member ID card for assistance with PA requirements.

* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

MULTI-BCBS-CR-038834-23-CPN38083

PUBLICATIONS: November 2023 Provider Newsletter