We are committed to reducing cost while improving health outcomes. To that end, effective March 1, 2021, we will require prior authorization for our commercial business for the following services:

 

Code

Description

53447

Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

53445

Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff

36465

Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)

36466

Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg

33477

Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed

 

Providers can submit pre-service review requests using one of the following ways:

  • Availity portal at www.availity.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
  • Call toll-free number at 800-531-4450, Monday – Friday, 8:30 a.m. to 5:00 p.m.

 

857-1220-PN-NE



Featured In:
December 2020 Anthem New Hampshire Provider News