CommercialOctober 1, 2023
Prior authorization requirement changes effective January 1, 2024 (MAC)
The following services will be added to precertification for the effective dates listed below.
Eligibility and benefits can be verified by accessing Availity Essentials* at 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.
Add to precertification | |||
Criteria | Criteria description | Code | Effective date |
DME.00032 | Automated External Defibrillators for Home Use | E0617 | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0260U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0264U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0265U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0266U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0267U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0268U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0269U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0270U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0271U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0272U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0273U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0274U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0276U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0277U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0278U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0332U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0335U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0336U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 0343U | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81441 | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81449 | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81451 | 1/1/2024 |
GENE.00052 | Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | 81456 | 1/1/2024 |
GENE.00057 | Gene Expression Profiling for Idiopathic Pulmonary Fibrosis | 81554 | 1/1/2024 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0564T | 1/1/2024 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 81535 | 1/1/2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0080U | 1/1/2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0247U | 1/1/2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0249U | 1/1/2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0360U | 1/1/2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 81538 | 1/1/2024 |
LAB.00015 | Detection of Circulating Tumor Cells | 0337U | 1/1/2024 |
LAB.00015 | Detection of Circulating Tumor Cells | 0338U | 1/1/2024 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 0002M | 1/1/2024 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 0003M | 1/1/2024 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 0344U | 1/1/2024 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 81596 | 1/1/2024 |
LAB.00024 | Immune Cell Function Assay | 86352 | 1/1/2024 |
LAB.00027 | Selected Blood, Serum and Cellular Allergy and Toxicity Tests | 86343 | 1/1/2024 |
LAB.00031 | Advanced Lipoprotein Testing | 0052U | 1/1/2024 |
LAB.00033 | Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer | 0228U | 1/1/2024 |
LAB.00033 | Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer | 0359U | 1/1/2024 |
LAB.00035 | Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis | 81490 | 1/1/2024 |
LAB.00036 | Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus | 0062U | 1/1/2024 |
LAB.00037 | Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS) | 0164U | 1/1/2024 |
LAB.00037 | Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS) | 0176U | 1/1/2024 |
LAB.00041 | Machine Learning Derived Probability Score for Rapid Kidney Function Decline | 0105U | 1/1/2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0346U | 1/1/2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0358U | 1/1/2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0361U | 1/1/2024 |
LAB.00048 | Pain Management Biomarker Analysis | 0117U | 1/1/2024 |
MED.00004 | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions | 0658T | 1/1/2024 |
MED.00004 | Noninvasive Imaging Technologies for the Evaluation of Skin Lesions | 96904 | 1/1/2024 |
* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.
GABCBS-CM-037997-23
PUBLICATIONS: October 2023 Provider Newsletter
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