Prior authorization requirements for HCPCS code 55899
Effective December 1, 2020, prior authorization (PA) requirements will change for HCPCS code 55899. This will be reviewed using MED.00132: Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures. This code will require PA by Anthem Blue Cross and Blue Shield for members. Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions/exclusions take precedence over these PA rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.
PA requirements will be added to the following:
- 55899 — Unlisted procedure, male genital system
To request PA, you may use one of the following methods:
- Web: availity.com
- Fax: 1-800-964-3627
- Phone: 1-855-558-1443
Not all PA requirements are listed here. PA requirements are available to contracted providers by accessing the Provider Self-Service Tool at availity.com by visiting https://mediproviders.anthem.com/wi > Login. Contracted and non-contracted providers who are unable to access Availity* may call Provider Services at 1-855-558-1443 for PA requirements.
* Availity, LLC is an independent company providing administrative support services on behalf of Anthem Blue Cross and Blue Shield.
November 2020 Anthem Provider News - Wisconsin