In the October 2020 edition of Provider News, we announced updates to prior authorizations that applied to Commercial Individual business effective January 1, 2021.  Please be advised that the prior authorization updates apply to all Commercial local business, including individual and group business. Also, the effective date of these updates is now February 1, 2021.

 

Please see below for the complete updated notice.

 

Anthem Blue Cross and Blue Shield in Indiana, Kentucky, Missouri, Ohio and Wisconsin is committed to reducing costs that are not medically necessary while improving health outcomes. To that end, effective February 1, 2021 Anthem Blue Cross and Blue Shield in Indiana, Kentucky, Missouri, Ohio and Wisconsin will require prior authorization for all of our commercial local business.

 

The following codes will require prior authorization with a date of service on or after February 1, 2021 for all of our commercial local business:

 

Medical Policy or

Clinical Guideline

Code(s)

CG-SURG-70
SURG.00026
SURG.00007

C1767

 

The following Clinical Guidelines have been adopted for all of our Commercial local business in Indiana, Kentucky, Missouri, Ohio and Wisconsin and will require prior authorization on or after February 1, 2021.

 

Clinical Guideline

Code

CG-DME-13

L5987

CG-DME-42

A9274, E0784, E0787, S1034

CG-DME-47

E0466, E0467

CG-OR-PR-04

S1040, L0112

CG-SURG-86

34705, 34841, 34842, 34843, 34844, 34845, 34846, 34847, 34848

 

The following Medical Policies have been reviewed and will require prior authorization for all of our Commercial local business in Indiana, Kentucky, Missouri, Ohio and Wisconsin, on or after February 1, 2021.

 

Medical Policy or

Clinical Guideline

Code

GENE.00054

0157U, 0158U, 0159U, 0160U, 0161U,

SURG.00121

33477

SURG.00010

53445, 53447

LAB.00016

81599

GENE.00011

81599

GENE.00037

81599

GENE.00020

81599

GENE.00016

81599

GENE.00018

81599

LAB.00019

81599

GENE.00023

81599

GENE.00009

81599

GENE.00026

81599

GENE.00052

81599

SURG.00007

C1767

CG-DME-44

E0766, A4555

GENE.00054

0157U, 0158U, 0159U, 0160U, 0161U

CG-SURG-95

C1767

SURG.00121

33477

 

776-1120-PN-CNT



Featured In:
November 2020 Anthem Provider News - Ohio