Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJuly 31, 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 care providers to search codes by the specific line of business 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 the Precertification Lookup Tool under the Claims drop-down.

Contracted care providers can also access the provider look up tool via Availity Essentials at 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 the phone numbers listed below:

  • Hoosier Healthwise — 866-408-6132
  • Healthy Indiana Plan — 844-533-1995
  • Hoosier Care Connect — 844-284-1798

CUMG number

CUMG title

CPT code

Clinical Guideline DME 13


MCG ACG A-0177 Cochlear Implant

NCD Cochlear Implantation
NCD Cochlear Implantation (50.3)

Lower Limb Prostheses
CG-DME-13 when a replacement / revision is requested ONLY (previously approved under INBCBS-CD-028626-23)

 ACG Cochlear Implant

 

NCD Cochlear Implantation 

 

L7510

LCD Lower Limb Prostheses (L33787)
LCD Lower Limb Prostheses

Clinical Guideline DME 13


LCD Lower Limb Prostheses (L33787)

Lower Limb Prostheses
CG-DME-13 when a replacement / revision is requested ONLY (previously approved under INBCBS-CD-028626-23)

LCD Lower Limb Prostheses (L33787)

L7520

UM AROW A2023M0965

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-050746-24-CPN50188

PUBLICATIONS: September 2024 Provider Newsletter