The following services will be added to precertification for the effective dates listed below.

 

To obtain precertification, providers can access Availity Essentials* at www.availity.com or call the Utilization Management department using the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member's care is medically necessary and administered at an appropriate network facility and by a network provider.

 

Criteria

Criteria description

Codes

Effective date

LAB.00011

Selected Protein Biomarker Algorithmic Assays

0080U

April 1, 2023

LAB.00011

Selected Protein Biomarker Algorithmic Assays

0092U

April 1, 2023

LAB.00011

Selected Protein Biomarker Algorithmic Assays

0174U

April 1, 2023

LAB.00011

Selected Protein Biomarker Algorithmic Assays

0247U

April 1, 2023

LAB.00011

Selected Protein Biomarker Algorithmic Assays

0249U

April 1, 2023

LAB.00015

Detection of Circulating Tumor Cells

0317U

April 1, 2023

SURG.00121

Transcatheter Heart Valve Procedures

0483T

April 1, 2023

SURG.00121

Transcatheter Heart Valve Procedures

0484T

April 1, 2023

SURG.00104

Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis

0510T

April 1, 2023

SURG.00104

Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis

0511T

April 1, 2023

SURG.00121

Transcatheter Heart Valve Procedures

0544T

April 1, 2023

SURG.00121

Transcatheter Heart Valve Procedures

0545T

April 1, 2023

LAB.00003

In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays

0564T

April 1, 2023

SURG.00121

Transcatheter Heart Valve Procedures

0646T

April 1, 2023

CG-SURG-95

Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention

64585

April 1, 2023

CG-MED-79

Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

C1823

April 1, 2023

SURG.00124

Carotid Sinus Baroreceptor Stimulation Devices

C1825

April 1, 2023

 

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


MEBCBS-CM-012053-22



Featured In:
January 2023 Provider Newsletter - Maine