Medicare AdvantageNovember 30, 2023
Prior authorization requirement changes effective March 1, 2024
Effective March 1, 2024, prior authorization (PA) requirements will change for the following codes. The medical codes listed below will require PA by Blue Medicare Advantage for Medicare 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 precertification rules and must be considered first when determining coverage.
Non-compliance with new requirements may result in denied claims.
Prior authorization requirements will be added for the following codes:
Code | Description |
33275 | Transcatheter removal of permanent leadless pacemaker, right ventricular |
33274 | Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (such as fluoroscopy, venous ultrasound, ventriculography, femoral venography) and device evaluation (such as interrogation or programming), when performed |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on Home | Blue Medicare Advantage on the Resources tab or for contracted providers by accessing Availity.com. Providers may also call number on the back of their patient’s member ID card for Provider Service for assistance with PA requirements.
UM AROW 4290
Blue Medicare Advantage is the trade name of Group Retiree Health Solutions, Inc., an independent licensee of the Blue Cross Blue Shield Association.
PAIBC-CR-047068-23-CPN41430
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