Anthem – Prior Authorization Update for Commercial Individual Business

The Medical Policies listed below, already being reviewed, will be moved to prior authorization for Commercial Individual business in Indiana, Kentucky, Missouri, Ohio and Wisconsin, on or after January 1, 2021.

Medical Policy or Clinical Guideline	Code
GENE.0005	0157U, 0158U, 0159U, 0160U, 0161U
SURG.00121	33477
SURG.00010	53445, 53447
LAB.00016	81599
GENE.00011	81599
GENE.00037	81599
GENE.00020	81599
GENE.00016	81599
GENE.00018	81599
LAB.00019	81599
GENE.00023	81599
GENE.00009	81599
GENE.00026	81599
GENE.00052	81599
SURG.00007	C1767
CG-DME-44	E0766, A4555
GENE.00054	0157U, 0158U, 0159U, 0160U, 0161U
CG-SURG-95	C1767
SURG.00121	33477

 

Source: https://providernews.anthem.com/missouri/article/prior-authorization-update-for-commercial-individual-business-1