CommercialMarch 1, 2024
Precertification list change notification
The following services will be added to precertification for the effective dates listed below.
To obtain precertification, providers can access 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.
Criteria | Criteria description | Code | Effective date |
CG-MED-88 | Preimplantation Embryo Biopsy and Genetic Testing | 0254U | June 1, 2024 |
CG-MED-88 | Preimplantation Embryo Biopsy and Genetic Testing | 0396U | June 1, 2024 |
CG-MED-95 | Transanal Irrigation | A4453 | June 1, 2024 |
CG-MED-95 | Transanal Irrigation | A4459 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L7510 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L7520 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | K1014 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5856 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5857 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5858 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5859 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5969 | June 1, 2024 |
CG-OR-PR-08 | Microprocessor Controlled Lower Limb Prosthesis | L5973 | June 1, 2024 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0769 | June 1, 2024 |
DME.00041 | Ultrasonic Diathermy Devices | K1036 | June 1, 2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0490 | June 1, 2024 |
DME.00043 | Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring | E0491 | June 1, 2024 |
Carelon Medical Benefits Management, Inc. Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0403U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0411U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0419U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0262U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0405U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0409U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0410U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0413U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0414U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0415U | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon Medical Benefit Management Genetic Testing Guideline | 0417U | June 1, 2024 |
LAB.00011 | Selected Protein Biomarker Algorithmic Assays | 0342U | June 1, 2024 |
LAB.00028 | Blood-based Biomarker Tests for Multiple Sclerosis | 0361U | June 1, 2024 |
LAB.00040 | Serum Biomarker Tests for Risk of Preeclampsia | 0390U | June 1, 2024 |
LAB.00041 | Machine Learning Derived Probability Score for Rapid Kidney Function Decline | 0407U | June 1, 2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer’s Disease | 0412U | June 1, 2024 |
MED.00143 | Ingestible Devices for the Treatment of Constipation | A9268 | June 1, 2024 |
MED.00143 | Ingestible Devices for the Treatment of Constipation | A9269 | June 1, 2024 |
MED.00145 | Digital Therapy Devices for Treatment of Amblyopia | A9292 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2022 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2023 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2024 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2025 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | C1832 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4285 | June 1, 2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4286 | June 1, 2024 |
SURG.00026 | Deep Brain, Cortical, and Cerebellar Stimulation | C1787 | June 1, 2024 |
SURG.00071 | Percutaneous and Endoscopic Spinal Surgery | C2614 | June 1, 2024 |
SURG.00144 | Occipital and Sphenopalatine Ganglion Nerve Block Therapy for the Treatment of Headache and Neuralgia | 64505 | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0494T | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0495T | June 1, 2024 |
TRANS.00009 | Portable Normothermic Organ Perfusion Systems | 0496T | June 1, 2024 |
Carelon Medical Benefits Management Guidelines | Carelon MBM Genetic Testing Guideline | 0088U | June 1, 2024 |
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-049257-24-SRS49256
PUBLICATIONS: March 2024 Provider Newsletter
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