CommercialDecember 30, 2022
Empire BlueCross BlueShield local precertification change in New York
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
The following services will be added to precertification for the effective dates listed below.
To submit precertification, providers can access Availity Essentials* at www.availity.com. 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.
Criteria | Criteria description | Codes | Effective date |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 0014M | April 1, 2023 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0080U | April 1, 2023 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0092U | April 1, 2023 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 0166U | April 1, 2023 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0174U | April 1, 2023 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0247U | April 1, 2023 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0248U | April 1, 2023 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0249U | April 1, 2023 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | 0278T | April 1, 2023 |
LAB.00015 | Detection of Circulating Tumor Cells | 0317U | April 1, 2023 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0324U | April 1, 2023 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0325U | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0483T | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0484T | April 1, 2023 |
SURG.00104 | Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis | 0510T | April 1, 2023 |
SURG.00104 | Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis | 0511T | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0544T | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0545T | April 1, 2023 |
MED.00103 | Automated Evacuation of Meibomian Gland | 0563T | April 1, 2023 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0564T | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0569T | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 0587T | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 0588T | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 0589T | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 0590T | April 1, 2023 |
SURG.00121 | Transcatheter Heart Valve Procedures | 0646T | April 1, 2023 |
MED.00004 | Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | 0658T | April 1, 2023 |
MED.00004 | Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | 0700T | April 1, 2023 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | 0720T | April 1, 2023 |
SURG.00145 | Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) | 33928 | April 1, 2023 |
SURG.00145 | Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts) | 33995 | April 1, 2023 |
SURG.00047 | Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia and Gastroparesis | 43236 | April 1, 2023 |
SURG.00047 | Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia and Gastroparesis | 43497 | April 1, 2023 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | 64555 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 64561 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 64566 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 64581 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | 64585 | April 1, 2023 |
LAB.00019 | Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | 81596 | April 1, 2023 |
MED.00002 | Selected Sleep Testing Services | 95803 | April 1, 2023 |
MED.00092 | Automated Nerve Conduction Testing | 95905 | April 1, 2023 |
MED.00004 | Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | 96931 | April 1, 2023 |
MED.00004 | Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | 96932 | April 1, 2023 |
MED.00004 | Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) | 96933 | April 1, 2023 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | C1767 | April 1, 2023 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | C1778 | April 1, 2023 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | C1787 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | C1820 | April 1, 2023 |
CG-MED-79 | Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems | C1823 | April 1, 2023 |
SURG.00124 | Carotid Sinus Baroreceptor Stimulation Devices | C1825 | April 1, 2023 |
CG-SURG-95 | Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention | C1883 | April 1, 2023 |
CG-DME-44 | Electric Tumor Treatment Field (TTF) | E0766 | April 1, 2023 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | K1002 | April 1, 2023 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | K1023 | April 1, 2023 |
* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield.
NYBCBS-CM-012055-22
PUBLICATIONS: January 2023 Newsletter
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