Effective April 1, 2021, prior authorization (PA) requirements will change for multiple codes. The medical codes listed below will require PA by Anthem Blue Cross and Blue Shield Medicaid for our members. Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to the following:

  • 54401 — Insertion, Penile Prosthesis; Inflatable (self-contained)
  • C1778 — Lead, neurostimulator (implantable)

 

To request PA, you may use one of the following methods:

 

Not all PA requirements are listed here. Detailed PA requirements are available to contracted providers by accessing the Precertification Lookup Tool on the Availity* Portal at availity.com or on the provider website at mediproviders.anthem.com/ky. Contracted and noncontracted providers who are unable to access Availity, may call Provider Services at 1-855-661-2028 for assistance with PA requirements.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Medicaid.



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March 2021 Anthem Provider News - Kentucky