Policy Updates Prior AuthorizationMedicaidOctober 10, 2024

Prior authorization requirement changes

Effective December 1, 2024  

Effective December 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Anthem for Medicaid 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 PA 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

Description

33263

Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Dual Lead System

33264

Removal Of Pacing Cardioverter-Defibrillator Pulse Generator With Replacement Of Pacing Cardioverter-Defibrillator Pulse Generator; Multiple Lead System

64582

Open implantation of hypoglossal nerve neurostimulator array, pulse generator, and distal respiratory sensor electrode or electrode array

To request PA, you may use one of the following methods:

  • Web: once logged in at Availity.com
  • Fax: 800-964-3627
  • Phone: 844-396-2330

Not all PA requirements are listed here. Detailed PA requirements are available to providers on providers.anthem.com/nv on the Resources tab or for contracted providers by accessing Availity.com. Providers may also call Provider Services at 844-396-2330 for assistance with PA requirements.

UM AROW A2024M1414

Anthem Blue Cross and Blue Shield Healthcare Solutions is the trade name of Community Care Health Plan of Nevada, Inc. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NVBCBS-CD-059312-24-CPN58059

PUBLICATIONS: November 2024 Provider Newsletter