Effective August 1, 2023, Anthem Blue Cross and Blue Shield is transitioning their medical necessity clinical criteria for oncology and chest imaging breast MRIs to Carelon Medical Benefits Management, Inc. The following procedures will be subjected to Carelon Medical Benefits Management prior authorization requirements for clinical appropriateness guidelines after August 1, 2023:
• 77046-Magnetic resonance imaging, breast, without contrast material; unilateral
• 77047- Magnetic resonance imaging, breast, without contrast material; bilateral
• 77048- Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis) when performed; unilateral
• 77049-Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization, and pharmacokinetic analysis) when performed; bilateral
• C8903- Magnetic resonance imaging with contrast, breast; unilateral
• C8905- Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral
• C8906- Magnetic resonance imaging with contrast, breast; bilateral
• C8908- Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral
For ways to submit Prior Authorizations to Carelon Medical Benefits Management, please click here.
To access Carelon Medical Benefits Management clinical guidelines, please click here.
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