Medicare AdvantageNovember 1, 2022
Anthem Blue Cross and Blue Shield expands specialty pharmacy precertification list
Effective for dates of service on and after December 1, 2022, the specialty Medicare Part B drugs 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 |
C9399, J3490, J3590, J9999 |
Opdualag (nivolumab and relatlimab-rmbw) |
C9096 |
Releuko (filgrastim-ayow) |
A9699 |
Pluvicto (lutetium lu 177 vipivotide tetraxetan) |
PUBLICATIONS: November 2022 Anthem Provider News - Wisconsin
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