Kentucky
Provider Communications
Changes to prior authorization (PA) requirements
PA requirements will be added to the following:
- T1019 – Personal care services, per 15 minutes, not for an inpatient or resident of a hospital, nursing facility, ICF/MR or IMD, part of the individualized plan of treatment (code may not be used to identify services provided by home health aide or certified nurse assistant)
- C9740 – Cystourethroscopy, with insertion of transprostatic implant; 4 or more implants
- E0953 – Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware
- E1031 – Rollabout chair, any and all types with castors 5 inches or greater
- E1090 – High-strength lightweight wheelchair, detachable arms, desk or full-length, swing-away detachable footrests
- E1130 – Standard wheelchair, fixed full-length arms, fixed or swing-away detachable footrests
- E1140 – Wheelchair, detachable arms, desk or full-length, swing-away detachable footrests
- E1260 – Lightweight wheelchair, detachable arms (desk or full-length) swing-away detachable footrest
- E1285 – Heavy-duty wheelchair, fixed full-length arms, swing-away detachable footrest
- E1290 – Heavy-duty wheelchair, detachable arms (desk or full-length) swing-away detachable footrest
- E2207 – Wheelchair accessory, crutch and cane holder
- E2378 – Power wheelchair component, actuator, replacement only
- K0039 – Leg strap, H style
Not all PA requirements are listed here. Detailed prior authorization requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com. Contracted and non-contracted providers who are unable to access the Availity Portal may call the number on the back of your patient’s Anthem ID card for PA requirements.
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Featured In:
September 2019 Anthem Provider News - Kentucky