Correction to Prior Authorization Update for Commercial business

In the October 2020 edition of Provider News, we announced updates to prior authorizations that applied to Commercial Individual business effective January 1, 2021.  Please be advised that the prior authorization updates apply to all Commercial local business, including individual and group business. Also, the effective date of these updates is now February 1, 2021.

 

Please see below for the complete updated notice.

 

Anthem Blue Cross and Blue Shield in Indiana, Kentucky, Missouri, Ohio and Wisconsin is committed to reducing costs that are not medically necessary while improving health outcomes. To that end, effective February 1, 2021 Anthem Blue Cross and Blue Shield in Indiana, Kentucky, Missouri, Ohio and Wisconsin will require prior authorization for all of our commercial local business.

 

The following codes will require prior authorization with a date of service on or after February 1, 2021 for all of our commercial local business:

 

Medical Policy or Clinical Guideline	Code(s)
CG-SURG-70 SURG.00026 SURG.00007	C1767

 

The following Clinical Guidelines have been adopted for all of our Commercial local business in Indiana, Kentucky, Missouri, Ohio and Wisconsin and will require prior authorization on or after February 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 following Medical Policies have been reviewed and will require prior authorization for all of our Commercial local business in Indiana, Kentucky, Missouri, Ohio and Wisconsin, on or after February 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

 

776-1120-PN-CNT