Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingAugust 16, 2024
Prior authorization requirement changes
Effective October 1, 2024
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 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.
Contracted providers can also access the provider look up tool via Availity Essentials at Availity.com by selecting Payer Spaces and then selecting the Pre-cert Lookup 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 |
Cardiovascular Surgery or Procedure GRG NCD Implantable Cardioverter Defibrillators (ICDs) | 33263 | |
Cardiovascular Surgery or Procedure GRG NCD Implantable Cardioverter Defibrillators (ICDs) | 33264 | |
Hypoglossal Nerve Stimulation, Implantable Neurosurgery or Procedure GRG LCD Hypoglossal Nerve Stimulation for the Treatment of Obstructive Sleep Apnea | 64582 | |
| Brachytherapy | C2616 |
NCD Therapeutic Embolization Neurosurgery or Procedure GRG Cardiovascular Surgery or Procedure GRG | S2095 |
UM AROW A2024M141
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-058750-24-CPN58059
PUBLICATIONS: September 2024 Provider Newsletter
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