Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingOctober 11, 2023

Durable medical equipment prior authorization update

Effective January 1, 2024*, 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 PA lookup tool allows providers to search codes by the specific line of business (Medicaid/SCHIP/Family Care or Hoosier Care Connect) to determine if PA is required and which guideline is utilized for the case review. To access the PA lookup tool, go to https://providers.anthem.com/in and select Precertification Lookup Tool under the Claims drop-down menu.

Detailed PA requirements are available to contracted providers via the provider self-service platform Availity Essentials. Go to Availity.com and select Payer Spaces. Under Payer Spaces, select Anthem Blue Cross Blue Shield payer tile, and then select Precertification Lookup Tool.

For assistance with 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

CPT code

Clinical UM Guidelines (CUMG) title

CUMG number

A4238 and E2102

MCG; MCR LCD glucose monitors

LCD glucose monitors (L33822)

LCD Glucose Monitors (L33822) Revision 12

*The effective date was changed from October 1, 2023 to January 1, 2024.

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

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-022591-23