Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 9, 2023

Carelon Medical Benefits Management, Inc. advanced imaging — Imaging of the brain CPT code list update

This communication applies to Commercial and Medicare Advantage plans from Anthem Blue Cross and Blue Shield (Anthem).

Effective for dates of service on and after December 1, 2023, the following code will require prior authorization through Carelon Medical Benefits Management, Inc.* (formerly AIM Specialty Health®).

CPT® code

Description

0042T

Cerebral Perfusion Analysis Using Computed Tomography with Contrast Administration, Including Post-Processing of Parametric Maps with Determination of Cerebral Blood Flow, Cerebral Blood Volume, and Mean Transit Time

As a reminder, ordering and servicing providers may submit prior authorization requests to Carelon in one of the following ways: 

  • Access Carelon’s ProviderPortalSM directly at providerportal.com: 
    • Online access is available 24/7 to process orders in real-time and is the fastest and most convenient way to request authorization.
  • Access Carelon via the Availity Essentials* website at availity.com.

Note: This update does not apply to the Federal Employee Program®.

If you have any questions related to guidelines, please contact Carelon via email at MedicalBenefitsManagement.guidelines@Carelon.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

* Carelon Medical Benefits Management, Inc. is an independent company providing utilization management services on behalf of the health plan. Availity, LLC is an independent company providing administrative support services on behalf of the health plan.

MULTI-BCBS-CRCM-025225-23-CPN25171

PUBLICATIONS: July 2023 Provider Newsletter