Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for AgingAugust 1, 2025

Precertification prior authorization requirement changes

Accurate coding is essential for providing superior care and a positive member experience. Please note that effective September 1, 2025, the following CPT® codes will require prior authorization (PA). All covered services are contingent upon medical necessity and benefit coverage at the time of service.

For questions regarding the PA requirement change, please contact Provider Services at 866-408-6132 (Hoosier Healthwise), 844-533-1995 (Healthy Indiana Plan), 844-284-1798 (Hoosier Care Connect), or 833-569-4739 (Indiana PathWays for Aging).

PA lookup tool

The PA lookup tool allows care 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 used for the case review. To access the PA lookup tool, go to https://www.anthem.com/in/provider and select the precertification lookup tool under the claims drop-down.

Contracted care providers can also access the provider lookup tool via Availity Essentials at https://Availity.com under Payer Services.

CUMG number

CUMG title

CPT code

MCG LCD: L38955

LCD Enteral Nutrition

B4161

MCG LCD: L34564

LCD Home Health Physical Therapy

G0151

MCG LCD: L34560

LCD Home Health Occupational Therapy

G0152

MCG LCD: L34563

LCD Home Health Speech Language Pathology

G0153

CG-MED-41

Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting

G0330

MCG SG-NS
MCG LCD: L16024

Neurosurgery or Procedure GRG
NCD Deep Brain Stimulation for Essential Tremor and Parkinson’s Disease

61863
61864
61867
61868

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, Hoosier Care Connect, and Indiana PathWays for Aging 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-086211-25