CommercialMarch 1, 2025
Precertification list change notification March 1, 2025
The following services will be added to precertification for the effective dates listed below.
Eligibility and benefits can be verified by visiting Availity at http://Availity.com or by calling the number on the back of the member’s identification card. Service precertification depends on the member’s benefit plan and eligibility at the time of review or approval. Since benefit plans can vary and may change depending on contract effective dates, it’s a good idea to verify member eligibility and the covered benefits.
If the requirements are not met, those services may be deemed ineligible for payment. Providers may appeal online through Availity Essentials, or by contacting Provider Services via the number on the back of our member ID card with additional information which may include medical records
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Add to precertification | |||
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Criteria |
Criteria description |
Code |
Effective date |
|
DME.00011 |
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices |
A4543 |
6/1/2025 |
|
DME.00011 |
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices |
A4544 |
6/1/2025 |
|
DME.00011 |
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices |
E0721 |
6/1/2025 |
|
DME.00011 |
Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices |
E0743 |
6/1/2025 |
|
DME.00012 |
Intrapulmonary Percussive Ventilation Devices |
A7021 |
6/1/2025 |
|
DME.00012 |
Intrapulmonary Percussive Ventilation Devices |
E0469 |
6/1/2025 |
|
DME.00052 |
Brain-Computer Interface Rehabilitation Devices |
E0738 |
6/1/2025 |
|
LAB.00003 |
In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays |
0511U |
6/1/2025 |
|
LAB.00015 |
Detection of Circulating Tumor Cells |
0490U |
6/1/2025 |
|
LAB.00015 |
Detection of Circulating Tumor Cells |
0491U |
6/1/2025 |
|
LAB.00015 |
Detection of Circulating Tumor Cells |
0492U |
6/1/2025 |
|
LAB.00026 |
Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions
|
0108U |
6/1/2025 |
|
LAB.00033 |
Protein Biomarkers for the Screening, Detection, and Management of Prostate Cancer |
0495U |
6/1/2025 |
|
LAB.00040 |
Serum Biomarker Tests for Risk of Preeclampsia |
0482U |
6/1/2025 |
|
LAB.00046 |
Testing for Biochemical Markers for Alzheimer's Disease |
0479U |
6/1/2025 |
|
LAB.00046 |
Testing for Biochemical Markers for Alzheimer's Disease |
0503U |
6/1/2025 |
|
LAB.00050 |
Metagenomic Sequencing for Infectious Diseases in the Outpatient Setting |
0480U |
6/1/2025 |
|
LAB.00051 |
Per- and Polyfluoroalkyl Substances PFAS Testing |
0394U |
6/1/2025 |
|
LAB.00051 |
Per- and Polyfluoroalkyl Substances PFAS Testing |
0457U |
6/1/2025 |
|
LAB.00051 |
Per- and Polyfluoroalkyl Substances PFAS Testing |
82542 |
6/1/2025 |
|
LAB.00051 |
Per- and Polyfluoroalkyl Substances PFAS Testing |
83921 |
6/1/2025 |
|
MED.00134 |
Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems
|
93701 |
6/1/2025 |
|
MED.00135 |
Gene Therapy for Hemophilia |
C9172 |
6/1/2025 |
|
MED.00150 |
Hepzato Kit™ (melphalan hepatic delivery system) |
J9248 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
A2027 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
A2028 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
A2029 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4334 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4335 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4336 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4337 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4338 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4339 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4340 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4341 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4342 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4343 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4344 |
6/1/2025 |
|
SURG.00011 |
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
Q4345 |
6/1/2025 |
|
SURG.00128 |
Implantable Left Atrial Hemodynamic Monitor |
0933T |
6/1/2025 |
|
SURG.00128 |
Implantable Left Atrial Hemodynamic Monitor |
0934T |
6/1/2025 |
|
SURG.00135 |
Renal Sympathetic Nerve Ablation |
0935T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0915T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0916T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0917T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0918T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0919T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0920T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0921T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0922T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0923T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0924T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0925T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0926T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0927T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0928T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0929T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0930T |
6/1/2025 |
|
SURG.00153 |
Cardiac Contractility Modulation Therapy |
0931T |
6/1/2025 |
Add to Precertification | |||
Criteria | Criteria Description | Code | Effective Date |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0742T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0899T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0900T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 78434 | 6/1/2025 |
UM AROW#: A202M2817
UM AROW#: A2024M2777
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-075840-24, NYBCBS-CM-076039-24-CPN75769
PUBLICATIONS: March 2025 Provider Newsletter
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