Anthem Blue Cross and Blue Shield | CommercialJuly 1, 2025
Anthem Blue Cross and Blue Shield VA Precertification/Prior Authorization list change notification July 1, 2025
The following services will be added to precertification/prior authorization for the effective dates listed below.
Precertification/prior authorization responsibility
The ordering or rendering care provider of the service is responsible for completing the precertification/prior authorization process.
If the requirements are not met, those services may be deemed ineligible for payment.
Providers may appeal online through Availity Essentials (https://Availity.com) or with additional information, which may include medical records
HMO plans: HMO members may not have benefits for non‑emergency services rendered outside of the network and are subject to review.
PPO plans: Precertification/prior authorization for services requiring prior approval is highly recommended.
EPO plans: Precertification/prior authorization for services requiring prior approval is highly recommended. No out‑of‑network benefit is available with the exception of ER/Urgent Care and authorized services.
To request precertification/prior authorization with the Virginia plan:
Log onto Availity Essentials at https://Availity.com.
For maternity, medical, and surgical precertification/prior authorization, contact Provider Services via the number on the back of our member ID card.
For mental health and substance use precertification/prior authorization, call 800‑755‑0851. Professionals are available 24 hours a day, seven days a week.
Add to precertification/prior authorization:
Criteria | Criteria description | Code | Effective date |
LAB.00035 | Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis | 0521U | 10/01/2025 |
LAB.00040 | Serum Biomarker Tests for Risk of Preeclampsia | 0524U | 10/01/2025 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0525U | 10/01/2025 |
SURG.00165 | Histotripsy | 0888T | 10/01/2025 |
SURG.00135 | Renal Sympathetic Nerve Ablation | 0935T | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | 15011 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | 15013 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | 15015 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | 15017 | 10/01/2025 |
MED.00057 | MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications | 61715 | 10/01/2025 |
SURG.00156 | Implanted Artificial Iris Devices | 66683 | 10/01/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 82233 | 10/01/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 82234 | 10/01/2025 |
LAB.00028, LAB.00046 | Blood-based Biomarker Tests for Multiple Sclerosis | 83884 | 10/01/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 84393 | 10/01/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 84394 | 10/01/2025 |
SURG.00135 | Renal Sympathetic Nerve Ablation | C1735 | 10/01/2025 |
SURG.00135 | Renal Sympathetic Nerve Ablation | C1736 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | C8002 | 10/01/2025 |
SURG.00162 | Implantable Shock Absorber for Treatment of Knee Osteoarthritis | C8003 | 10/01/2025 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | C9807 | 10/01/2025 |
SURG.00155 | Cryoneurolysis | C9808 | 10/01/2025 |
SURG.00155 | Cryoneurolysis | C9809 | 10/01/2025 |
DME.00053 | Home Video-Assisted Robotic Rehabilitation Systems | E0739 | 10/01/2025 |
MED.00152 | Outpatient Intravenous Insulin Therapy | G9147 | 10/01/2025 |
MED.00135 | Gene Therapy for Hemophilia | J1414 | 10/01/2025 |
MED.00140, MED.00146 | Gene Therapy for Beta Thalassemia | J3392 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4346 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4347 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4348 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4349 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4350 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4351 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4352 | 10/01/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4353 | 10/01/2025 |
UM AROW A2025M3530
Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
VABCBS-CM-085466-25
PUBLICATIONS: July 2025 Provider Newsletter
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