State & FederalMedicaidMarch 1, 2022

Changes to precertification

Effective March 1, 2022, Anthem Blue Cross and Blue Shield Medicaid added the precertification requirement for participating providers for any place of service request other than POS 12 (home) or POS 11 (office) for the following codes:

 

CPT® code

Description

95800

Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (such as, by airflow or peripheral arterial tone), and sleep time

95801

Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, and respiratory analysis (such as, by airflow or peripheral arterial tone)

95805

Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory

95806

Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory

95807

Sleep study, attended

95808

Polysomnography; any age, sleep staging with one to three additional parameters of sleep, attended by a technologist

95810

Polysomnography; ages 6 years or older, sleep staging with four or more additional parameters of sleep, attended by a technologist

95811

Polysomnography; ages 6 years or older, sleep staging with four or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bi‑level ventilation, attended by a technologist

 

When is precertification required?

The removal of the precertification requirement for POS 12 (home) or POS 11 (office) does not apply to nonparticipating providers.

 

Questions?

If you have questions about this communication, please contact your Provider Experience representative or Provider Services at 855-661-2028.

 

AKY-NU-0383-22 (AKYPEC-3040-21)

PUBLICATIONS: March 2022 Anthem Provider News - Kentucky