Posted in Insurance, Training, Updates

Anthem Medi-Cal: Radiotherapies and radioimmunotherapies will require prior authorization 04/01/2021

PA requirements will be added to the following codes:

  • A9543 Injection, Yttrium Y-90 ibritumomab tiuxetan (Zevalin)
  • A9590 Injection, Iodine I-131, iobenguane, 1 mCi (Azedra)
  • A9513 Injection, Lutetium Lu 177, dotatate, therapeutic, 1 millicurie (Lutathera)
  • A9606 Injection, Radium ra-223 dichloride, therapeutic, per microcurie (Xofigo)

Effective 04/01/2021 the above codes will require an auth.

Providers have 2 ways to order a PA:

Federal and state law, as well as state contract language, including definitions and specific contract provisions/exclusions, take precedence over these PA rules and must be considered first when determining coverage.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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