Prior authorization requirement changes for codes A0426 and A0428 effective October 1, 2021

Effective October 1, 2021, prior authorization (PA) requirements will change for A0426 and A0428 covered by Anthem Blue Cross and Blue Shield. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these prior authorization rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added for the following codes:

• A0426 — ambulance service, advanced life support, nonemergency transport, level 1 (ALS 1)
• A0428 — ambulance service, basic life support, nonemergency transport (BLS)

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the provider self-service tool on the Availity* Portal at availity.com or on the provider website at anthem.com/medicareprovider > Login. Contracted and non-contracted providers unable to access Availity can call the Provider Services located on the back of their patient’s member ID card for PA requirements.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.

 

ABSCRNU-0232-21