Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingApril 29, 2025

Prior authorization requirement changes

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

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

Contracted providers can also access the precertification lookup tool via Availity Essentials at https://Availity.com. Select Payer Spaces; then, select the precertification lookup tool tile.

For assistance with questions regarding the PA requirement change, call Provider Services at one of these phone numbers:

  • Hoosier Healthwise — 866-408-6132
  • Healthy Indiana Plan — 844-533-1995
  • Hoosier Care Connect — 844-284-1798
  • Indiana PathWays for Aging — 833-569-4739

CUMG number

CUMG title

CPT code

MCG A-0893

Home ventilator, dual-function respiratory device, also performs additional function of cough stimulation, includes all accessories, components, and supplies for all functions

E0468

MCG A-0884

Cough stimulating device, alternating positive and negative airway pressure

E0482

MCG LCD L33690

Automatic external defibrillator

E0617

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-072384-24

PUBLICATIONS: May 2025 Provider Newsletter