Prior authorization requirements for HCPCS code 55899
Please note, this communication applies to Anthem HealthKeepers Plus offered by HealthKeepers, Inc.
Effective December 1, 2020, prior authorization (PA) requirements will change for HCPCS code 55899. This will be reviewed using MED.00132: Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures. This code will require PA by HealthKeepers, Inc. for Anthem HealthKeepers Plus 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. Noncompliance with new requirements may result in denied claims.
PA requirements will be added to the following:
- 55899 — Unlisted procedure, male genital system
To request PA, you may use one of the following methods:
- Fax: 1-800-964-3627
- Phone: 1-800-901-0020
Not all PA requirements are listed here. PA requirements are available to contracted providers by accessing the Provider Self-Service Tool at https://www.availity.com by visiting https://mediproviders.anthem.com/va > Login. Contracted and noncontracted providers who are unable to access Availity* may call Provider Services at 1-800 901-0020 or Anthem CCC Plus Provider Services at 1‑855‑323‑4687 for PA requirements.
November 2020 Anthem Provider News - Virginia