Policy Updates Prior AuthorizationMedicare AdvantageMarch 27, 2025

Outpatient preapproval update from Carelon Medical Benefits Management, Inc.

Effective for dates of service on and after July 1, 2025, the following non-emergency transportation code requires preapproval through Carelon Medical Benefits Management.

CPT® code

Description

A0425

Ground mileage, per statute mile

As a reminder, ordering and servicing providers may submit preapproval requests to Carelon Medical Benefits Management in one of several ways:

  • Visit Carelon Medical Benefits Management’s providerportal.com:
    • Online access is available 24/7 to process orders in real‑time and is the fastest and most convenient way to request authorization.
  • Access via https://Availity.com.

If you have questions, please contact Carelon Medical Benefits Management via email at MedicalBenefitsManagement.guidelines@Carelon.com or visit https://guidelines.carelonmedicalbenefitsmanagement.com.

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CR-078792-25-CPN77989

PUBLICATIONS: April 2025 Provider Newsletter