Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 14, 2025

Prior authorization requirement changes

Effective May 1, 2025

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

The precertification lookup tool allows providers to search codes by the specific Medicaid line of business (Hoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and Indiana PathWays for Aging) to determine if a PA is required and which guideline is used for the case review. To access the precertification lookup tool at https://providers.anthem.com/in, select Precertification Lookup Tool under the Claims drop-down.

Contracted providers can also access the precertification look up tool via Availity Essentials at https://Availity.com. Log in, select Payer Spaces, then select the pre‑certification 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 codes

MCG: ACG: A-0326

Skin Substitute, Tissue-Engineered (Human Cellular), for Diabetic Foot Ulcer and Venous Ulcer

15271, 15273, 15275, 15277, Q4101, Q4106

MCG: MCR: NCD N2705

NCD Porcine Skin and Gradient Pressure Dressings

C9364, Q4102, Q4103, Q4118, Q4124, Q4130, Q4135, Q4136, Q4142, Q4166, Q4175

UM AROW A2025M2991

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-077528-25