Notice of Material Amendment: Prior authorization requirement changes

Effective April 1, 2024, prior authorization (PA) requirements will change for the following codes. The medical codes listed below will require PA by Anthem Blue Cross and Blue Shield for Medicaid members. 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. Non-compliance with new requirements may result in denied claims.

PA requirements will be added for these service codes because Milliman Care Guidelines (MCG) criteria have determined that their current role remains uncertain and, based on the review of existing evidence, there is no clinical indication for the technology.

Refer to attachment to view full details