Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 15, 2023

Durable medical equipment prior authorization update

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

The prior authorization (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 providers.anthem.com/in and select Precertification Lookup Tool under the Claims drop-down.

Detailed PA requirements are available to contracted providers via the provider self-service tool on Availity Essentials* at Availity.com, or go to providers.anthem.com/in and select Log in to Availity.

For assistance with questions regarding the PA requirement change, please 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

CUMG number

CUMG title

CPT code

MCG: ACG: A-0893

Home ventilator, any type, used with invasive interface, (for example, tracheostomy tube)

E0465

CG-DME-47

MCG: A-0893

Home ventilator, multi-function respiratory device, also performs any or all of the additional functions of oxygen concentration, drug nebulization, aspiration, and cough stimulation, includes all accessories, components, and supplies for all functions

E0467

IHCP DME Module

Speech generating device, digitized speech, using pre-recorded messages, 8 min. or less

E2500

IHCP DME Module

Speech generating device, digitized speech, using pre-recorded messages, 8-20 min.

E2502

IHCP DME Module

Speech generating device, digitized speech, using pre-recorded messages, over 40 min.

E2506

IHCP DME Module

Speech generating device, synthesized speech, requiring message formulation by spelling

E2508

IHCP DME Module

Accessory for speech generating device, mounting system

E2512

UM AROW #4230

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

INBCBS-CD-023883-23-CPN23495

PUBLICATIONS: September 2023 Provider Newsletter