Policy Updates Prior AuthorizationCommercialSeptember 1, 2024

Precertification List Change Notification September 1, 2024

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

To obtain precertification, providers can access Availity (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

ANC.00008

Cosmetic and Reconstructive Services of the Head and Neck

21086

12/1/2024

ANC.00008

Cosmetic and Reconstructive Services of the Head and Neck

L8045

12/1/2024

CG-DME-31

Powered Wheeled Mobility Devices

E2298

12/1/2024

CG-SURG-118

Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)

0450T

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0141U

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0142U

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0321U

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0369U

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0370U

12/1/2024

LAB.00039

Combined Pathogen Identification and Drug Resistance Testing

Previously Titled: Pooled Antibiotic Sensitivity Testing

0373U

12/1/2024

LAB.00046

Testing for Biochemical Markers for Alzheimer's Disease

0445U

12/1/2024

MED.00125

Biofeedback and Neurofeedback

S9002

12/1/2024

OR-PR.00008

Osseointegrated Limb Prostheses

L5991

12/1/2024

RAD.00059

Catheter-based Embolization Procedures for Malignant Lesions Outside the Liver

C9797

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

A2026

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

C9796

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4305

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4306

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4307

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4308

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4309

12/1/2024

SURG.00011

Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

Q4310

12/1/2024

SURG.00158

Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain

A4438

12/1/2024

SURG.00162

Implantable Shock Absorber for Treatment of Knee Osteoarthritis

C1734

12/1/2024

UM AROW #:A2024M1872

Commercial services provided by Anthem Blue Cross, trade name of Anthem HealthChoice HMO, Inc. and Anthem HealthChoice Assurance, Inc.
Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

NYBC-CM-064281-24-SRS63548

PUBLICATIONS: September 2024 Provider Newsletter