Products & ProgramsAnthem Blue Cross and Blue Shield | CommercialOctober 1, 2018

New precertification requirements for certain cardiovascular diagnostic and interventional services begins January 1, 2019

Anthem Blue Cross and Blue Shield and our affiliate HealthKeepers Inc. are committed to helping ensure our members receive patient care that is consistent with recognized best practices. To support this goal, beginning with dates of service on and after January 1, 2019, Anthem will expand our cardiovascular program to require precertification for arterial ultrasound, cardiac catheterization, and percutaneous coronary intervention (PCI). The program will be managed by AIM Specialty Health® (AIM), a separate company administering the program on behalf of Anthem.

 

Please note that all Anthem local members who currently require precertification for high-tech imaging and echocardiograms are included in the program. The program does not apply to Federal Employee Program® (FEP).   Additionally, procedures performed in an inpatient setting or on an emergent basis are not included in the program.

 

Arterial ultrasound, cardiac catheterization, and percutaneous coronary intervention (PCI) services will be reviewed using AIM clinical guidelines which are available at aimproviders.com/cardiology/. 

 

Ordering physicians may submit to AIM a precertification request in one of several ways:

 

  • Access AIM 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.

 

 

  • Call the AIM Contact Center toll-free number: 866-789-0158, Monday–Friday, 8 a.m. – 5 p.m.

 

Anthem recognizes that the necessity for arterial duplex imaging or percutaneous coronary intervention (PCI) may not be identified by providers until their patients have undergone a physiologic study or cardiac catheterization.  We ask that you contact AIM no later than 10 business days after you perform arterial duplex imaging or PCI, but before you submit the claim, to request clinical appropriateness review. The following codes will be reviewed by AIM as part of the program:

 

 

CPT

Description

93922

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries

93923

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels

93924

Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing

93925

Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study

93926

Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study

93930

Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study

93931

Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study

93978

Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study

93979

Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study

93880

Duplex scan of extracranial arteries; complete bilateral study 

93882

Duplex scan of extracranial arteries; unilateral or limited study

93454

Catheter placement in coronary artery(s) for coronary angiography

93455

Catheter placement in coronary artery(s) for coronary angiography, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography 

93456

Catheter placement in coronary artery(s) for coronary angiography, with right heart catheterization 

93457

Catheter placement in coronary artery(s) for coronary angiography, with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) including intraprocedural injection(s) for bypass graft angiography and right heart catheterization 

93458

Catheter placement in coronary artery(s) for coronary angiography, with left heart catheterization including intraprocedural injection(s) for left ventriculography

93459

Catheter placement in coronary artery(s) for coronary angiography, with left heart catheterization including intraprocedural injection(s) for left ventriculography, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 

93460

Catheter placement in coronary artery(s) for coronary angiography, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography 

93461

Catheter placement in coronary artery(s) for coronary angiography, with right and left heart catheterization including intraprocedural injection(s) for left ventriculography, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography 

92920

Percutaneous transluminal coronary angioplasty; single major coronary artery or branch 

92924

Percutaneous transluminal coronary atherectomy, with coronary angioplasty when performed; single major coronary artery or branch 

92928

Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch 

92933

Percutaneous transluminal coronary atherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch 

92937

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel 

92943

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; single vessel 

 

For questions regarding precertification or prior authorization requirements, please contact the provider service number on the back of the member ID card.

 

 

PUBLICATIONS: October 2018 Anthem Provider Newsletter - Virginia