Prior authorization requirement changes effective May 1, 2024 

Effective May 1, 2024, prior authorization (PA) requirements will change for the following code(s).  The medical code(s) listed below will require PA for by Anthem for Medicare members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these precertification rules and must be considered first when determining coverage. 

Non-compliance with new requirements may result in denied claims.

Prior authorization requirements will be added for the following code(s):

Not all PA requirements are listed here. Detailed PA requirements are available to providers on https://providers.anthem.com/ny on the Resources tab or for contracted providers by accessing Availity.com. Providers may also call the number on the back of their patient’s member ID card for Provider Services.