Prior authorization requirements for 55899

Effective March 1, 2021, prior authorization (PA) requirements will change for 55899. The Medical codes listed below will require PA by Empire BlueCross BlueShield HealthPlus. 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 PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

 

PA requirements will be added to the following:

• 55899 — Unlisted procedure, male genital system

 

To request PA, you may use one of the following methods:

• Web: availity.com
• Fax: 1-800-964-3627
• Phone: 1-800-450-8753

Not all PA requirements are listed here. PA requirements are available to contracted providers by accessing the Provider Self-Service Tool at https://www.availity.com by visiting www.empireblue.com/nymedicaiddoc > Login. Contracted and noncontracted providers who are unable to access Availity* may call Provider Services at 1-800-450-8753 for PA requirements.

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield HealthPlus.

 

NYE-NU-0281-20 December 2020