CommercialSeptember 1, 2024
Precertification List change notification
The following services will be added to precertification effective December 1, 2024.
Eligibility and benefits can be verified by accessing Availity Essentials at availity.com or by calling the number on the back of the member’s identification card. Service precertification is based on the member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for the verification of member eligibility and covered benefits.
Except in the case of an emergency, failure to obtain precertification before rendering the designated services listed below may result in denial of reimbursement.
Add to precertification | |||
Criteria | Criteria description | Code | Effective date |
ANC.00008 | Cosmetic and Reconstructive Services of the Head and Neck | 21086 | 12/01/2024
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ANC.00008 | Cosmetic and Reconstructive Services of the Head and Neck | L8045 | 12/01/2024 |
CG-DME-31 | Powered Wheeled Mobility Devices | E2298 | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0141U | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0142U | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0321U | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0369U | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0370U | 12/01/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0373U | 12/01/2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0445U | 12/01/2024 |
MED.00125 | Biofeedback and Neurofeedback | S9002 | 12/01/2024 |
OR-PR.00008 | Osseointegrated Limb Prostheses | L5991 | 12/01/2024 |
RAD.00059 | Catheter-based Embolization Procedures for Malignant Lesions Outside the Liver | C9797 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2026 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | C9796 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4305 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4306 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4307 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4308 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4309 | 12/01/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4310 | 12/01/2024 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | A4438 | 12/01/2024 |
SURG.00162 | Implantable Shock Absorber for Treatment of Knee Osteoarthritis | C1734 | 12/01/2024 |
Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
NVBCBS-CM-063750-24
PUBLICATIONS: September 2024 Provider Newsletter
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