Policy Updates Prior AuthorizationAnthem Blue Cross and Blue Shield | Medicare AdvantageAMH Health, LLC | Medicare AdvantageMay 22, 2025

Precertification/prior authorization requirement changes

Effective October 1, 2025, precertification/prior authorization requirements will change for the following code(s). The medical code(s) listed below will require precertification/prior authorization by Anthem for Medicare Advantage members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage.

Those services may be deemed ineligible for payment if the requirements are unmet.

Care providers may appeal online through Availity Essentials (https://Availity.com) or by phone by calling with additional information, which may include medical records.

Precertification/prior authorization requirements will be added for the following code(s):

Code

Description

0521U

Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood

0524U

Obstetrics (preeclampsia), sFlt1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value

0525U

Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib)

0686T

Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

0888T

Histotripsy (i.e., non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance

0935T

Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), and fluoroscopy, bilateral

60660

Percutaneous ablation of 1 or more thyroid nodule(s)

60661

Percutaneous ablation of additional lobe of thyroid nodule(s)

61715

MRI guided focused ultrasound high intensity stereotactic intracranial ablation

82233

Beta-amyloid; 1-40

82234

Beta-amyloid; 1-42

83884

Neurofilament light chain

84393

Tau, phosphorylated

84394

Tau, total

C1735

Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components

C1736

Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components

C8003

Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)

C9804

Elastomeric infusion pump (e.g., On-Q* pump with bolus), including catheter and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

C9808

Nerve cryoablation probe (e.g., cryoICE, cryoSPHERE, cryoSPHERE MAX, cryo2), including probe and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

C9809

Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

E0683

Non-pneumatic, non-sequential, peristaltic wave compression pump

E0739

Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, sensors

E1822

Dynamic adjustable ankle extension only device, includes soft interface material

E1823

Dynamic adjustable ankle flexion only device, includes soft interface material

E1828

Dynamic adjustable toe extension only device, includes soft interface material

E1829

Dynamic adjustable toe flexion only device, includes soft interface material

Not all precertification/prior authorization requirements are listed here. Detailed precertification/prior authorization requirements are available to care providers on https://anthem.com/provider or for contracted care providers by accessing https://Availity.com. Care providers may also contact Provider Services via the number on the back of our member ID card for assistance with precertification/prior authorization requirements.

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.

Plans offered by AMH Health, LLC., a joint venture between MaineHealth and Anthem Partnership Holding Company, LLC. AMH Health is an independent licensee of the Blue Cross Blue Shield Association.

MEBCBS-CR-084743-25, CPN84299

PUBLICATIONS: June 2025 Provider Newsletter