Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 2, 2025

Precertification/prior authorization requirement changes

Effective June 1, 2025, the below CPT® codes will require precertification/prior authorization. All covered services are contingent upon medical necessity and benefit coverage at the time of service.

The precertification/prior authorization lookup tool allows providers to search codes by the specific Medicaid line of business to determine whether precertification/prior authorization is required and which guideline is used for the case review. To access the precertification/prior authorization lookup tool, go to https://providers.anthem.com/in and select the precertification/prior authorization lookup tool under the Claims drop-down.

Contracted providers can also access the precertification/prior authorization look up tool via Availity Essentials at https://Availity.com by logging in, selecting Payer Spaces, then selecting the precertification/prior authorization look up tool tile.

For assistance with questions regarding the precertification/prior authorization 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
  • Indiana PathWays for Aging – 833‑412‑4405

CUMG number

CUMG title

CPT code

MCG GRG: SG-NS (ISC GRG)

Neurosurgery pt Procedure GRG

61624

MCG NCD: N2016

NCD Cardic Output Monitoring by Thoracic Electrical Bioimpedance

93701

MCG ACG: A-0487

Lower Limb Prosthesis

L5783, L5841

UM AROW A2025M2968

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 IN 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-078453-25

PUBLICATIONS: May 2025 Provider Newsletter