Prior Authorization Requirements Change for K1022 (Healthy Blue + Medicare HMO-DSNP)

Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).

On November 1, 2022, prior authorization (PA) requirements will change for a code covered by Blue Cross NC. 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.

Prior authorization requirements will be added for the following codes:

• K1022 — Addition to lower extremity prosthesis, endoskeletal, knee disarticulation, above knee, hip disarticulation, positional rotation unit, any type

Not all PA requirements are listed here. PA requirements are available to contracted providers at the Healthy Blue + Medicare website or by accessing Availity. Once logged in to Availity at https://availity.com, select Patient Registration, then Authorizations & Referrals, then choose Authorizations or Auth/Referral Inquiry, as appropriate. Contracted and noncontracted providers who are unable to access Availity may call the number on the back of the member’s ID card.

Note: Availity, LLC is an independent company providing administrative support services for Healthy Blue + Medicare providers on behalf of Blue Cross and Blue Shield of North Carolina.

For more information, visit Healthy Blue + Medicare.

BNCCARE-0261-22 August 2022