Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 13, 2024

Prior authorization requirement changes

Effective October 1, 2024, the below CPT® codes 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 used for the case review. To access the PA lookup tool, go to providers.anthem.com/in, and select the precertification lookup tool under the Claims drop-down menu.

Contracted providers can also access the provider look up tool via Availity Essentials at Availity.com, selecting the Payer Spaces then select the pre-cert look up tool tile.

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
  • Indiana PathWays for Aging — 833-412-4405

CUMG number

CUMG title

CPT code

MCG A-0487

MCG LCD L33787

CG-DME-13

Lower Limb Prosthesis

LCD Lower Limb Prosthesis

Lower Limb Prosthesis; Lower Limb Accessories, Maintenance, Repairs, and Replacements

L5926

MCG A-0487

MCG LCD L33787

CG-DME-13

Lower Limb Prosthesis

LCD Lower Limb Prosthesis

Lower Limb Prosthesis; Lower Limb Accessories, Maintenance, Repairs, and Replacements

L5615

MCG A-0974

MCG SG-NS

Phrenic Nerve Stimulation, Implantable

Neurosurgery pr Procedure GRG

33276

MCG A-0974

MCG SG-NS

Phrenic Nerve Stimulation, Implantable

Neurosurgery pr Procedure GRG

33277

UM AROW A202M1495 and A202M1670

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-059868-24

PUBLICATIONS: September 2024 Provider Newsletter