Material Adverse Change (MAC)

The following services will be added to precertification for the effective dates listed below.

 

To obtain precertification, providers can access Availity Essentials* at www.availity.com. Service preapproval is based on member’s benefit plan/eligibility at the time the service is reviewed/approved.

 

Precertification can help avoid unnecessary charges or penalties by helping to ensure that the member's care is medically necessary and administered at an appropriate network facility and by a network provider.

 

Criteria

Criteria description

Codes

Effective date

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

96365

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

96372

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

J0456

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

J0696

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

J0698

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

J2540

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9494

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9497

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9500

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9501

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9502

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9503

April 1, 2023

MED.00013

Parenteral Antibiotics for the Treatment of Lyme Disease

S9504

April 1, 2023

 

* Availity, LLC is an independent company providing administrative support services on behalf of Empire BlueCross BlueShield.


NYBCBS-CM-012059-22



Featured In:
January 2023 Newsletter