Anthem Blue Cross and Blue Shield | CommercialSeptember 1, 2024
Precertification List Change Notification September 1, 2024
The following services will be added to precertification for the effective dates listed below.
Precertification responsibility
The ordering or rendering provider of service is responsible for completing the prior authorization process.
HMO plans: Services that require precertification will be denied if rendered without the appropriate prior authorization for in-network providers. HMO members may not have benefits for non-emergency services rendered outside of the network and are subject to review and may be denied.
PPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement.
EPO plans: Precertification for services requiring prior approval is highly recommended. If not completed in advance, a pre-payment review of the claim will occur and may result in a denial of claim reimbursement. No out of network benefit is available with the exception of ER/Urgent Care and authorized services.
To request precertification with the Virginia Plan
Access Availity (Availity.com).
For maternity, medical, surgical precertification, call the number listed on the back of the member’s ID card.
For mental health and substance abuse 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 |
ANC.00008 | Cosmetic and Reconstructive Services of the Head and Neck | 21086 | 12/1/2024 |
ANC.00008 | Cosmetic and Reconstructive Services of the Head and Neck | L8045 | 12/1/2024 |
CG-DME-31 | Powered Wheeled Mobility Devices | E2298 | 12/1/2024 |
CG-SURG-118 | Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) | 0450T | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0141U | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0142U | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0321U | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0369U | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0370U | 12/1/2024 |
LAB.00039 | Combined Pathogen Identification and Drug Resistance Testing | 0373U | 12/1/2024 |
LAB.00046 | Testing for Biochemical Markers for Alzheimer's Disease | 0445U | 12/1/2024 |
MED.00125 | Biofeedback and Neurofeedback | S9002 | 12/1/2024 |
OR-PR.00008 | Osseointegrated Limb Prostheses | L5991 | 12/1/2024 |
RAD.00059 | Catheter-based Embolization Procedures for Malignant Lesions Outside the Liver | C9797 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | A2026 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | C9796 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4305 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4306 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4307 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4308 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4309 | 12/1/2024 |
SURG.00011 | Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting | Q4310 | 12/1/2024 |
SURG.00158 | Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain | A4438 | 12/1/2024 |
SURG.00162 | Implantable Shock Absorber for Treatment of Knee Osteoarthritis | C1734 | 12/1/2024 |
UM AROW #:A2024M1872
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-064282-24-SRS63548
PUBLICATIONS: September 2024 Provider Newsletter
To view this article online:
Or scan this QR code with your phone