CommercialApril 1, 2025
Precertification list change notification April 1, 2025
Eligibility and benefits can be verified by accessing https://Availity.com or by calling the number on the back of the member’s identification card. Service precertification is based on member’s benefit plan/eligibility at the time the service is reviewed/approved. Benefit plans vary widely and are subject to change based on the contract effective dates. The provider is responsible for verification of member eligibility and covered benefits.
If the requirements are not met, those services may be deemed ineligible for payment. Providers may appeal online through Availity Essentials or contact Provider Service via the number on the back of our member ID card for additional information which may include medical records.
Add to precertification
Criteria | Clinical description | Code | Effective date |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6026 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6611 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6677 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6715 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6880 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6881 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6882 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6925 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6935 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6945 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6955 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6965 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L6975 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7007 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7008 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7009 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7045 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7180 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7181 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7190 | July 1, 2025 |
CG‑OR‑PR‑05 | Myoelectric Upper Extremity Prosthetic Devices | L7191 | July 1, 2025 |
CG‑DME‑13, CG‑OR‑PR‑05, CG‑OR‑PR‑08 | Lower Limb Prosthesis Myoelectric Upper Extremity Prosthetic Devices Microprocessor Controlled Lower Limb Prosthesis | L7510 | July 1, 2025 |
CG‑DME‑13, CG‑OR‑PR‑05, CG‑OR‑PR‑08 | Lower Limb Prosthesis Myoelectric Upper Extremity Prosthetic Devices Microprocessor Controlled Lower Limb Prosthesis | L7520 | July 1, 2025 |
UM AROW A224M2887
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-076480-25
PUBLICATIONS: April 2025 Provider Newsletter
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