Policy Updates Prior AuthorizationMedicare AdvantageAugust 7, 2023

Prior authorization requirement changes effective December 1, 2023

Effective December 1, 2023, prior authorization (PA) requirements will change for the following code(s).  The medical code(s) listed below will require PA by Anthem Blue Cross and Blue Shield for Medicare 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. Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Code

Code description

64581

Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement)

64628

Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral

C1764

Event recorder, cardiac (implantable)

E0466

Home ventilator, any type, used with non-invasive interface, (for example, mask, chest shell)

E0766

Electrical stimulation device used for cancer treatment, includes all accessories, any type

L5845

Knee-Shin Sys Stance Flexion

L5910

Endo Below Knee Alignable Sy

Not all PA requirements are listed here. Detailed PA requirements are available to providers on anthem.com/medicareprovider on the Resources tab or for contracted providers by accessing Availity.com.* Providers may also call the number on the back of the member’s ID card for assistance with PA requirements.

* Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

UM AROW# 4489

MULTI-BCBS-CR-028201-23-CPN27653

PUBLICATIONS: September 2023 Provider Newsletter