Prior Authorization requirement changes effective December 1, 2023 (Healthy Blue + Medicare (D-SNP))
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Effective December 1, 2023, prior authorization (PA) requirements will change for the following code(s). The medical code(s) listed below will require PA by Blue Cross NC for Medicare 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 precertification rules and must be considered first when determining coverage. Non-compliance with new requirements may result in denied claims.
Prior authorization requirements will be added for the following code(s):
| Code | Code Description |
| 64581 | Incision for implantation of neurostimulator electrode array; sacral nerve (transforaminal placement) |
| 64628 | Thermal destruction of intraosseous basivertebral nerve, including all imaging guidance; first 2 vertebral bodies, lumbar or sacral |
| C1764 | Event recorder, cardiac (implantable) |
| E0466 | Home ventilator, any type, used with non-invasive interface, (for example, mask, chest shell) |
| E0766 | Electrical stimulation device used for cancer treatment, includes all accessories, any type |
| L5845 | Knee-Shin Sys Stance Flexion |
| L5910 | Endo Below Knee Alignable Sy |
Not all PA requirements are listed here. Detailed PA requirements are available to providers on provider.healthybluenc.com on the Resources tab or for contracted providers by accessing Availity.com. Providers may also call the number on the back of the member’s ID card for assistance with PA requirements.
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 further information, please visit Healthy Blue + Medicare.
NCBCBS-CR-028204-23-CPN27653 UM AROW# 4489