The following services will be added to precertification for the effective dates listed below.

Precertification responsibility

The ordering or rendering provider of service is responsible for completing the prior authorization process.

 

HMO plans: Services that require precertification will be denied if rendered without the appropriate prior authorization for in-network providers. HMO members may not have benefits for
non-emergency services rendered outside of the network and are subject to review and may be denied.

 

PPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement.

 

EPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement. No out-of-network benefit is available with the exception of ER/Urgent Care and authorized services.

To request precertification with the Virginia plan

Access Availity* at https://www.availity.com for Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc., or call the number listed on the back of the member’s ID card.

 

For mental health and substance abuse precertification, call 800-755-0851. Professionals are available 24 hours a day, seven days a week.

 

Add to Precertification

Criteria

Criteria description

Code

Effective date

LAB.00031

Advanced lipoprotein testing

0052U

Add 01/01/2023

MED.00118

Continuous monitoring of intraocular pressure

0329T

Add 01/01/2023

SURG.00150

Leadless pacemaker

33274

Add 01/01/2023

SURG.00150

Leadless pacemaker

33275

Add 01/01/2023

MED.00115

Outpatient cardiac hemodynamic monitoring using a wireless sensor for heart failure management

33289

Add 01/01/2023

SURG.00032

Patent foramen ovale and left atrial appendage closure devices for stroke prevention

33340

Add 01/01/2023

SURG.00121

Transcatheter heart valve procedures

33418

Add 01/01/2023

SURG.00116

High resolution anoscopy screening for anal intraepithelial neoplasia (AIN) and squamous cell cancer of the anus

46601

Add 01/01/2023

SURG.00116

High resolution anoscopy screening for anal intraepithelial neoplasia (AIN) and squamous cell cancer of the anus

46607

Add 01/01/2023

SURG.00010

Treatments for urinary incontinence

53445

Add 01/01/2023

SURG.00010

Treatments for urinary incontinence

53446

Add 01/01/2023

SURG.00010

Treatments for urinary incontinence

53448

Add 01/01/2023

SURG.00010

Treatments for urinary incontinence

53449

Add 01/01/2023

SURG.00077

Uterine fibroid ablation: laparoscopic, percutaneous or transcervical image guided techniques

58674

Add 01/01/2023

SURG.00026

Deep brain, cortical, and cerebellar stimulation

61850

Add 01/01/2023

SURG.00026

Deep brain, cortical, and cerebellar stimulation

61860

Add 01/01/2023

SURG.00144

Occipital nerve block therapy for the treatment of headache and occipital neuralgia

64405

Add 01/01/2023

SURG.00140

Peripheral nerve blocks for treatment of neuropathic pain

64415

Add 01/01/2023

SURG.00140

Peripheral nerve blocks for treatment of neuropathic pain

64417

Add 01/01/2023

SURG.00140

Peripheral nerve blocks for treatment of neuropathic pain

64447

Add 01/01/2023

SURG.00140;
SURG.00144

Peripheral nerve blocks for treatment of neuropathic pain;
occipital nerve block therapy for the treatment of headache and occipital neuralgia

64450

Add 01/01/2023

SURG.00151

Balloon dilation of the eustachian tubes

69705

Add 01/01/2023

SURG.00151

Balloon dilation of the eustachian tubes

69706

Add 01/01/2023

CG-MED-51;
RAD.00038

Three-dimensional (3-D) rendering of imaging studies;
use of 3-D, 4-D or 5-D ultrasound in maternity care

76376

Add 01/01/2023

CG-MED-51;
RAD.00038

Three-dimensional (3-D) rendering of imaging studies;
use of 3-D, 4-D or 5-D ultrasound in maternity care

76377

Add 01/01/2023

LAB.00033

Protein biomarkers for the screening, detection and management of prostate cancer

81539

Add 01/01/2023

MED.00125

Biofeedback and neurofeedback

90875

Add 01/01/2023

MED.00125

Biofeedback and neurofeedback

90876

Add 01/01/2023

MED.00115

Outpatient cardiac hemodynamic monitoring using a wireless sensor for heart failure management

93264

Add 01/01/2023

RAD.00064

Myocardial sympathetic innervation imaging with or without single-photon emission computed tomography (SPECT)

A9582

Add 01/01/2023

MED.00115

Outpatient cardiac hemodynamic monitoring using a wireless sensor for heart failure management

C2624

Add 01/01/2023

DME.00037

Cooling devices and combined cooling/heating devices

E0218

Add 01/01/2023

MED.00125

Biofeedback and neurofeedback

E0746

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J0558

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J0561

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J0690

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J0743

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J1267

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J1335

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J1956

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J2185

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J2280

Add 01/01/2023

MED.00013

Parenteral antibiotics for the treatment of Lyme disease

J2510

Add 01/01/2023

 

* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc.


VABCBS-CM-006249-22

 

 



Featured In:
October 2022 Anthem Provider News - Virginia