Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2024

Notice of material change/amendment to contract

Precertification list change notification July 1, 2024

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

To obtain precertification, providers can access Availity (Availity.com) or call Anthem’s

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.

Add to precertification

Criteria

Criteria description

Code

Effective date

SURG.00142

Genicular Procedures for Treatment of Knee Pain

Previously titled: Genicular Nerve Blocks and Ablation for Chronic Knee Pain

37242

10/1/2024

SURG.00150

Leadless Pacemaker

0823T

10/1/2024

SURG.00150

Leadless Pacemaker

0824T

10/1/2024

SURG.00150

Leadless Pacemaker

0825T

10/1/2024

SURG.00150

Leadless Pacemaker

0826T

10/1/2024

SURG.00152

Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing

0861T

10/1/2024

SURG.00152

Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing

0862T

10/1/2024

SURG.00152

Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing

0863T

10/1/2024

SURG.00157

Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis

31242

10/1/2024

SURG.00157

Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis

31243

10/1/2024

SURG.00158

Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

64596

10/1/2024

SURG.00158

Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

64597

10/1/2024

UM AROW# A2024M1436

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Maine, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MEBCBS-CM-058788-24-CPN57724

PUBLICATIONS: July 2024 Provider Newsletter