CommercialMedicare AdvantageMarch 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Carelon Medical Benefits Management (formerly AIM Specialty Health) Radiology Clinical Appropriateness Guidelines CPT code list update
This communication applies to Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield.
Effective for dates of service on and after June 1, 2023, the following code updates will apply to the Carelon Medical Benefits Management, Inc. Radiology Clinical Appropriateness Guidelines.
Advanced imaging of the abdomen and pelvis
CPT® code | Description |
0648T | Quantitative magnetic resonance for analysis of tissue composition (for example, fat, iron, water content), including multiparametric data acquisition, data preparation and transmission, interpretation, and report, obtained without diagnostic MRI examination of the same anatomy (for example, organ, gland, tissue, target structure) during the same session. |
Oncologic imaging
CPT code | Description |
0633T | CT Breast W/3d Rendering Uni without contrast |
0634T | CT Breast W/3d Rendering Uni with contrast |
0635T | CT Breast W/3d Rendering Uni with or without contrast |
0636T | CT Breast W/3d Rendering Bi without contrast |
0637T | CT Breast W/3d Rendering Bi with contrast |
0638T | CT Breast W/3d Rendering Bi with or without contrast |
As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon in one of several ways:
- Access the ProviderPortalSM directly at providerportal.com.
- Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
- Access the Availity* website at availity.com.
If you have questions related to guidelines, please email MedicalBenefitsManagement.guidelines@carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield. Carelon Medical Benefits Management, Inc. is an independent company providing some utilization review services on behalf of Anthem Blue Cross and Blue Shield.
MULTI-BCBS-CRCM-013590-22-CPN12763
PUBLICATIONS: March 2023 Anthem Provider News - Ohio
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