Policy Updates Prior AuthorizationMedicare AdvantageOctober 31, 2023

Prior authorization requirement changes effective March 1, 2024 

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

Effective March 1, 2024, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Empire BlueCross BlueShield 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):

Code

Description

33275

Transcatheter removal of permanent leadless pacemaker, right ventricular

33274

Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (such as fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (such as interrogation or programming), when performed

Not all PA requirements are listed here. Detailed PA requirements are available to providers by visiting Medicare Advantage Providers | EmpireBlue.com > Providers > Claims > Prior Authorization, or for contracted providers by accessing Availity.com. Providers may also call number on the back of their patient’s member ID card for Provider Service for assistance with PA requirements.

UM AROW 4290

Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans.

NYBCBS-CR-042755-23-CPN41430

PUBLICATIONS: December 2023 Provider Newsletter