AdministrativeCommercialNovember 30, 2020

Prior authorization updates for commercial business effective March 1, 2021

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

Empire BlueCross BlueShield (“Empire”) is committed to reducing cost while improving health outcomes. To that end, effective March 1, 2021 Empire will require prior authorization for our commercial business

for the following services:

 

E0766

Electrical stimulation device used for cancer treatment, includes all accessories, any type

53447

Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

53445

Insertion of inflatable urethral/bladder neck sphincter, including placement of pump, reservoir, and cuff

C1767

Generator, neurostimulator (implantable), non-rechargeable

36465

Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein)

36466

Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg

33477

Transcatheter pulmonary valve implantation, percutaneous approach, including pre-stenting of the valve delivery site, when performed

 

Providers can submit pre-service review requests using one of the following ways:

  • Availity Portal at https://www.availity.com. Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
  • Call toll-free number at 1-800-982-8089, Monday through Friday 8:30 a.m. to 5:00 p.m. ET.

 

857-1220-PN-NY

 

PUBLICATIONS: December 2020 Empire Provider News