Anthem Blue Cross and Blue Shield | Medicare AdvantageJuly 28, 2023
UPDATED: Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
**This collateral ran originally in the July 1, 2023, newsletter and was also posted on the provider portal with an October 1, 2023, effective date. The new date of service will begin on November 1, 2023.**
Effective for dates of service on and after November 1, 2023, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process.
Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
HCPCS or CPT® codes | Medicare Part B drugs |
J1931 | Aldurazyme (laronidase) |
J0256 | Aralast NP (alpha-1 proteinase inhibitor), Prolastin-C (alpha-1 proteinase inhibitor), Zemaira (alpha-1 proteinase inhibitor) |
J1786 | Cerezyme (imiglucerase) |
J0584 | Crysvita (burosumab-twza) |
J1743 | Elaprase (idursulfase) |
J3060 | Elelyso (taliglucerase) |
J0180 | Fabrazyme (agalsidase beta) |
J0257 | Glassia (alpha-1 proteinase inhibitor) |
J0638 | Ilaris (canakinumab) |
J0221 | Lumizyme (alglucosidase alfa) |
J3397 | Mepsevii (vestronidase alfa) |
J1458 | Naglazyme (galsulfase) |
J0219 | Nexviazyme (avalglucosidase alfa-ngpt) |
J0222 | Onpattro (patisiran) |
J1322 | Vimizim (elosulfase alfa) |
J3385 | Vpriv (velaglucerase) |
J0775 | Xiaflex (collagenase clostridium histolyticum) |
MULTI-BCBS-CR-032240-23-CPN31947
PUBLICATIONS: September 2023 Provider Newsletter
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