Anthem Blue Cross and Blue Shield (Anthem) of Indiana, Kentucky, Missouri, Ohio and Wisconsin is committed to reducing costs while improving health outcomes. To that end, effective January 1, 2021, Anthem will require prior authorization for our Commercial Individual business.

 

The following codes will require prior authorization with a date of service on or after January 1, 2021:

 

Medical Policy or Clinical Guideline

Code

CG-SURG-70
SURG.00026
SURG.00007

C1767

 

The Clinical Guidelines listed below have been adopted for our Commercial Individual business in Indiana, Kentucky, Missouri, Ohio and Wisconsin and will require prior authorization on or after January 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 Medical Policies listed below, already being reviewed, will be moved to prior authorization for our Commercial Individual business in Indiana, Kentucky, Missouri, Ohio and Wisconsin, on or after January 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

 

714-1020-PN-CNT



Featured In:
October 2020 Anthem Provider News - Ohio