Policy Updates Prior AuthorizationCommercialMarch 12, 2024

Anthem Precertification List Change Notification for September 2023

This article was previously posted with archived criteria CG-SURG-27 which has been removed. Previous article here.

The following services will be added to precertification for the effective dates listed below.

To obtain precertification, providers can access Availity Essentials (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

CG-SURG-88

Mastectomy for Gynecomastia

19300

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D7899

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9950

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9951

12/01/2023

CG-SURG-09

Temporomandibular Disorders

D9952

12/01/2023

CG-DME-45

Ultrasound Bone Growth Stimulation

E0760

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

K1024

12/01/2023

CG-DME-06

Compression Devices for Lymphedema

K1025

12/01/2023

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.

NYBCBS-CM-050240-24-SRS49080

PUBLICATIONS: April 2024 Provider Newsletter