Policy Updates Prior AuthorizationMedicare AdvantageJune 27, 2025

Precertification/prior authorization requirement changes

Effective November 1, 2025, precertification/prior authorization requirements for the following codes will change. The medical codes listed below will require precertification/prior authorization by Anthem for Medicare Advantage 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.

If the requirements are not met, those services may be deemed ineligible for payment.

Care providers may appeal online through Availity Essentials (https://Availity.com) or by phone by calling with additional information, which may include medical records.

Precertification/prior authorization requirements will be added for the following codes:

Code

Description

0521U

Rheumatoid factor IgA and IgM, cyclic citrullinated peptide (CCP) antibodies, and scavenger receptor A (SR-A) by immunoassay, blood

0524U

Obstetrics (preeclampsia), sFlt1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value

0525U

Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib)

0686T

Histotripsy (non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance

0888T

Histotripsy (non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance

0909T

Replacement of integrated neurostimulation system, vagus nerve, including analysis and programming, when performed

0910T

Removal of integrated neurostimulation system, vagus nerve

0911T

Electronic analysis of implanted integrated neurostimulation system, vagus nerve; without programming by physician or other qualified health care professional

0912T

Electronic analysis of implanted integrated neurostimulation system, vagus nerve; with simple programming by physician or other qualified health care professional

0935T

Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), and fluoroscopy, bilateral

15011

Harvest of skin for autograft; first

15012

Harvest of skin for autograft; each additional 25 sq cm

15013

Preparation of skin autograft, requiring enzymatic processing; first 25 sq cm or less

15014

Preparation of skin autograft, requiring enzymatic processing; each additional 25 sq cm

15015

Application of skin autograft; first 480 sq cm or less

15016

Application of skin autograft; each additional 480 sq cm

15017

Application of skin autograft; first 480 sq cm or less

15018

Application of skin autograft; each additional 480 sq cm

60660

Percutaneous ablation of 1 or more thyroid nodule(s)

60661

Percutaneous ablation of additional lobe of thyroid nodule(s)

61715

MRI guided focused ultrasound high intensity stereotactic intracranial ablation

82233

Beta-amyloid; 1-40

82234

Beta-amyloid; 1-42

83884

Neurofilament light chain

84393

Tau, phosphorylated

84394

Tau, total

C1735

Catheter(s), intravascular for renal denervation, radiofrequency, including all single use system components

C1736

Catheter(s), intravascular for renal denervation, ultrasound, including all single use system components

C8002

Preparation of skin cell suspension autograft, automated, including all enzymatic processing and device components (do not report with manual suspension preparation)

C8003

Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (e.g., fluoroscopy)

C9804

Elastomeric infusion pump (e.g., On-Q* pump with bolus), including catheter and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

C9808

Nerve cryoablation probe (e.g., cryoICE, cryoSPHERE, cryoSPHERE MAX, cryo2), including probe and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

C9809

Cryoablation needle (e.g., iovera system), including needle/tip and all disposable system components, nonopioid medical device (must be a qualifying Medicare nonopioid medical device for postsurgical pain relief in accordance with Section 4135 of the CAA, 2023)

E0683

Non-pneumatic, non-sequential, peristaltic wave compression pump

E0739

Rehabilitation system with interactive interface providing active assistance in rehabilitation therapy, includes all components and accessories, motors, microprocessors, senso

E1822

Dynamic adjustable ankle extension only device, includes soft interface material

E1823

Dynamic adjustable ankle flexion only device, includes soft interface material

E1828

Dynamic adjustable toe extension only device, includes soft interface material

E1829

Dynamic adjustable toe flexion only device, includes soft interface material

Not all precertification/prior authorization requirements are listed here. Detailed precertification/prior authorization requirements are available to care providers on https://www.anthem.com/nv/provider or, for contracted care providers, by accessing https://Availity.com. Care providers may also contact Provider Services via the number on the back of our member ID card for assistance with precertification/prior authorization requirements.

Published in the August 2025 Provider Newsletter
UM AROW A2025M3433

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.

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