CommercialNovember 1, 2024
Precertification List Change Notification — November 1, 2024
The following services will be added to precertification for the effective dates listed below.
To obtain precertification, providers can access Availity @ www.availity.com or call Anthem’s Utilization Management department using the number on the back of the member’s identification card. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved.
Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member's care is medically necessary and administered at an appropriate network facility and by a network provider.
Add to Precertification | |||
Criteria | Criteria Description | Code | Effective Date |
LAB.00042 | Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy | 0456U | 2/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer’s Disease | 0459U | 2/1/2025 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis | 0468U | 2/1/2025 |
TRANS.00039 | Portable Normothermic Organ Perfusion Systems | 0894T | 2/1/2025 |
TRANS.00039 | Portable Normothermic Organ Perfusion Systems | 0895T | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0687 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0688 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0689 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J0744 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2183 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2184 | 2/1/2025 |
MED.00013 | Parenteral Antibiotics for the Treatment of Lyme Disease | J2281 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4311 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4312 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4313 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4314 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4315 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4316 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4317 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4318 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4319 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4320 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4321 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4322 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4323 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4324 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4325 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4326 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4327 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4328 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4329 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4330 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4331 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4332 | 2/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4333 | 2/1/2025 |
UM AROW A2024M2180
Commercial services provided by Anthem Blue Cross and Blue Shield, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc., or Anthem Blue Cross and Blue Shield HP, trade name of Anthem HP, LLC.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-067491-24
PUBLICATIONS: November 2024 Provider Newsletter
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