Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 22, 2023

Carelon Medical Benefits Management, Inc. lumbar infusion update

Effective November 1, 2023, the CPT® codes below will require prior authorization (PA). All covered services are contingent upon medical necessity and benefit coverage at the time of service.

The Precertification Lookup Tool allows providers to search codes by the specific line of business (Hoosier Healthwise, Healthy Indiana Plan, or Hoosier Care Connect) to determine if PA is required and which guideline is used for the case review. To access the Precertification Lookup Tool, go to https://bit.ly/3BELDtc, and select Precertification Lookup Tool under the Claims drop-down.

Contracted providers can also access the tool via Availity Essentials* at availity.com. Select Anthem under Payer Spaces then select Precertification Lookup Tool.

If you have questions regarding the PA requirement change, call Provider Services at one of the phone numbers listed below:

  • Hoosier Healthwise — 866-408-6132
  • Healthy Indiana Plan — 844-533-1995
  • Hoosier Care Connect — 844-284-1798

Clinical Utilization Management Guidelines (CUMG) number

CUMG title

CPT code

ISC (S-820) 

 

Lumbar fusion

Lumbar infusion

63052

ISC (S-820) 

 

Lumbar fusion

Lumbar infusion

63053

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Availity, LLC. is an independent company providing administrative support on behalf of Anthem Blue Cross and Blue Shield.

INBCBS-CD-024698-23

PUBLICATIONS: July 2023 Provider Newsletter