Anthem Blue Cross and Blue Shield | CommercialMarch 1, 2025
Notice of material change/amendment to contract
Precertification list change notification March 1, 2025
The following services will be added to precertification for the effective dates listed below.
To obtain precertification, providers can access Availity Essentials at https://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.
If the requirements are not met, those services may be deemed ineligible for payment. Providers may appeal online through Availity Essentials or phone Anthem Provider Services with additional information which may include medical records
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 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | A4543 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | A4544 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0721 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0743 | 6/1/2025 |
DME.00012 | Intrapulmonary Percussive Ventilation Devices | A7021 | 6/1/2025 |
DME.00012 | Intrapulmonary Percussive Ventilation Devices | E0469 | 6/1/2025 |
DME.00052 | Brain Computer Interface Rehabilitation Devices | E0738 | 6/1/2025 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0511U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0490U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0491U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0492U | 6/1/2025 |
LAB.00026 | Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions | 0108U | 6/1/2025 |
LAB.00033 | Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer | 0495U | 6/1/2025 |
LAB.00040 | Serum Biomarker Tests for Risk of Preeclampsia | 0482U | 6/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0479U | 6/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0503U | 6/1/2025 |
LAB.00050 | Metagenomic Sequencing for Infectious Diseases in the Outpatient Setting | 0480U | 6/1/2025 |
LAB.00051 | Per‑ and Polyfluoroalkyl Substances PFAS Testing | 0394U | 6/1/2025 |
LAB.00051 | Per‑ and Polyfluoroalkyl Substances PFAS Testing | 0457U | 6/1/2025 |
LAB.00051 | Per‑ and Polyfluoroalkyl Substances PFAS Testing | 82542 | 6/1/2025 |
LAB.00051 | Per‑ and Polyfluoroalkyl Substances PFAS Testing | 83921 | 6/1/2025 |
MED.00134 | Non‑invasive Heart Failure and Arrhythmia Management and Monitoring Systems | 93701 | 6/1/2025 |
MED.00135 | Gene Therapy for Hemophilia | C9172 | 6/1/2025 |
MED.00150 | Hepzato Kit™ (melphalan hepatic delivery system) | J9248 | 6/1/2025
|
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2027 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2028 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2029 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4334 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4335 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4336 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4337 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4338 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4339 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4340 | 6/1/2025
|
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4341 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4342 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4343 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4344 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4345 | 6/1/2025 |
SURG.00128 | Implantable Left Atrial Hemodynamic Monitor | 0933T | 6/1/2025 |
SURG.00128 | Implantable Left Atrial Hemodynamic Monitor | 0934T | 6/1/2025 |
SURG.00135 | Renal Sympathetic Nerve Ablation | 0935T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0915T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0916T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0917T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0918T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0919T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0920T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0921T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0922T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0923T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0924T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0925T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0926T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0927T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0928T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0929T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0930T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0931T | 6/1/2025 |
Add to Precertification | |||
Criteria | Criteria Description | Code | Effective Date |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0742T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0899T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0900T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 78434 | 6/1/2025 |
UM AROW #: A2024M2813
UM AROW #: A2024M2777
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-076042-24-CPN75838, MEBCBS-CM-076036-24-CPN75769
PUBLICATIONS: March 2025 Provider Newsletter
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