Anthem Blue Cross and Blue Shield | CommercialMarch 1, 2025
Precertification list change notification March 1, 2025
The following services will be added to precertification for the effective dates listed below.
Precertification responsibility
It is the responsibility of the ordering or rendering provider to complete the prior authorization process.
If the requirements aren't fully met, there is a possibility that those services may not qualify for payment. Providers may appeal online through the Availity Essentials platform or by calling the number on the back of the member ID card with any pertinent additional information which may include medical records.
Health maintenance organization (HMO) plans: HMO members may not have benefits for non‑emergency services. Non‑emergency services rendered outside of the network are subject to review.
Preferred provider organization (PPO) plans: Precertification for services requiring prior approval is highly recommended.
Exclusive provider organization (EPO) plans: Precertification for services requiring prior approval is highly recommended. With the exception of emergency room/urgent care and authorized services, no out‑of-network benefits are available.
To request precertification:
Eligibility and benefits can be verified by visiting Availity Essentials at http://Availity.com:
- For maternity, medical, or surgical precertification, please call the number listed on the back of the member’s ID card.
- For mental health and substance use disorder 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 |
CG-SURG-76 | Carotid, Vertebral, and Intracranial Artery Stent Placement with or without Angioplasty | 61624 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | A4543 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | A4544 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0721 | 6/1/2025 |
DME.00011 | Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices | E0743 | 6/1/2025 |
DME.00012 | Intrapulmonary Percussive Ventilation Devices | A7021 | 6/1/2025 |
DME.00012 | Intrapulmonary Percussive Ventilation Devices | E0469 | 6/1/2025 |
DME.00052 | Brain-Computer Interface Rehabilitation Devices | E0738 | 6/1/2025 |
LAB.00003 | In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | 0511U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0490U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0491U | 6/1/2025 |
LAB.00015 | Detection of Circulating Tumor Cells | 0492U | 6/1/2025 |
LAB.00026 | Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions
| 0108U | 6/1/2025 |
LAB.00033 | Protein Biomarkers for the Screening, Detection, and Management of Prostate Cancer | 0495U | 6/1/2025 |
LAB.00040 | Serum Biomarker Tests for Risk of Preeclampsia | 0482U | 6/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0479U | 6/1/2025 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0503U | 6/1/2025 |
LAB.00050 | Metagenomic Sequencing for Infectious Diseases in the Outpatient Setting | 0480U | 6/1/2025 |
LAB.00051 | Per- and Polyfluoroalkyl Substances PFAS Testing | 0394U | 6/1/2025 |
LAB.00051 | Per- and Polyfluoroalkyl Substances PFAS Testing | 0457U | 6/1/2025 |
LAB.00051 | Per- and Polyfluoroalkyl Substances PFAS Testing | 82542 | 6/1/2025 |
LAB.00051 | Per- and Polyfluoroalkyl Substances PFAS Testing | 83921 | 6/1/2025 |
MED.00134 | Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems Previously titled: Non-invasive Heart Failure and Arrhythmia Management and Monitoring System | 93701 | 6/1/2025 |
MED.00135 | Gene Therapy for Hemophilia | C9172 | 6/1/2025 |
MED.00150 | Hepzato Kit™ (melphalan hepatic delivery system) | J9248 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2027 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2028 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2029 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4334 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4335 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4336 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4337 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4338 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4339 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4340 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4341 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4342 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4343 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4344 | 6/1/2025 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4345 | 6/1/2025 |
SURG.00128 | Implantable Left Atrial Hemodynamic Monitor | 0933T | 6/1/2025 |
SURG.00128 | Implantable Left Atrial Hemodynamic Monitor | 0934T | 6/1/2025 |
SURG.00135 | Renal Sympathetic Nerve Ablation | 0935T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0915T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0916T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0917T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0918T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0919T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0920T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0921T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0922T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0923T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0924T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0925T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0926T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0927T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0928T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0929T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0930T | 6/1/2025 |
SURG.00153 | Cardiac Contractility Modulation Therapy | 0931T | 6/1/2025 |
Add To Precertification | |||
Criteria | Criteria Description | Code | Effective Date |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0742T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0899T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 0900T | 6/1/2025 |
RAD.00069 | Absolute Quantitation of Myocardial Blood Flow Measurement | 78434 | 6/1/2025 |
UM AROW #: A2024M2820
UM AROW #: A2024M2819
UM AROW #: A2024M2777
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-075845-24, VABCBS-CM-075844-24, VABCBS-CM-076040-24-CPN75769
PUBLICATIONS: March 2025 Provider Newsletter
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