Policy Updates Medical Policy & Clinical GuidelinesHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingMarch 25, 2025

Prior authorization update

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

Our precertification lookup tool allows providers to search codes by the specific line of business (Medicaid/SCHIP/Family Care or Hoosier Care Connect) to determine if preapproval is required and which guideline is used for the case review. To access the tool, go to https://providers.anthem.com/in and select Precertification Lookup Tool under the Claims dropdown menu.

Detailed preapproval requirements are available to contracted providers via the provider self‑service tool on Availity Essentials at https://Availity.com.

For help with questions about this 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
  • PathWays for Aging — 833‑569-4739

Clinical Utilization Management Guidelines (CUMG)

CUMG number

CUMG title

CPT® code

Lumbar Diskectomy, Foraminotomy, or Laminotomy

ORG: S‑810 (ISC)

MCG ORG S-810

Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral disc, 1 interspace, lumbar

62380

Sacroiliac Joint Fusion 24-10-20

Carelon Medical Benefits Management, Inc., and Indiana PathWays for Aging

Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed

27280

Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan.

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-074337-24

PUBLICATIONS: April 2025 Provider Newsletter