Prior authorization requirements for 0200T and 0201T

Effective September 1, 2020, prior authorization (PA) requirements will change for 0200T and 0201T. The medical codes listed below will require PA for Anthem Blue Cross and Blue Shield Healthcare Solutions 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. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to the following:

• 0200T — Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, one or more needles
• 0201T — Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, two or more needles

 

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

• Web: availity.com*
• Fax: 1-800-964-3627
• Phone: 1-844-396-2330

 

Not all PA requirements are listed here. PA requirements are available to contracted providers by accessing the Provider Self-Service Tool at www.availity.com at https://mediproviders.anthem.com/nv >

Login. Contracted and noncontracted providers who are unable to access Availity may call Provider Services at

1-844-396-2330 for assistance with PA requirements.

 

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield Healthcare Solutions.

 

 

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