CommercialOctober 1, 2020
Prior authorization update for Commercial Individual Business
Anthem Blue Cross and Blue Shield (Anthem) of Indiana, Kentucky, Missouri, Ohio and Wisconsin is committed to reducing costs while improving health outcomes. To that end, effective January 1, 2021, Anthem will require prior authorization for our Commercial Individual business.
The following codes will require prior authorization with a date of service on or after January 1, 2021:
Medical Policy or Clinical Guideline |
Code |
CG-SURG-70 |
C1767 |
The Clinical Guidelines listed below have been adopted for our Commercial Individual business in Indiana, Kentucky, Missouri, Ohio and Wisconsin and will require prior authorization on or after January 1, 2021.
Clinical Guideline |
Code |
CG-DME-13 |
L5987 |
CG-DME-42 |
A9274, E0784, E0787, S1034 |
CG-DME-47 |
E0466, E0467 |
CG-OR-PR-04 |
S1040, L0112 |
CG-SURG-86 |
34705, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848 |
The Medical Policies listed below, already being reviewed, will be moved to prior authorization for our Commercial Individual business in Indiana, Kentucky, Missouri, Ohio and Wisconsin, on or after January 1, 2021.
Medical Policy or Clinical Guideline |
Code |
GENE.00054 |
0157U, 0158U, 0159U, 0160U, 0161U, |
SURG.00121 |
33477 |
SURG.00010 |
53445, 53447 |
LAB.00016 |
81599 |
GENE.00011 |
81599 |
GENE.00037 |
81599 |
GENE.00020 |
81599 |
GENE.00016 |
81599 |
GENE.00018 |
81599 |
LAB.00019 |
81599 |
GENE.00023 |
81599 |
GENE.00009 |
81599 |
GENE.00026 |
81599 |
GENE.00052 |
81599 |
SURG.00007 |
C1767 |
CG-DME-44 |
E0766, A4555 |
GENE.00054 |
0157U, 0158U, 0159U, 0160U, 0161U |
CG-SURG-95 |
C1767 |
SURG.00121 |
33477 |
PUBLICATIONS: October 2020 Anthem Provider News - Missouri
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