Anthem is continuing its process to transition to Availity. In late April, Anthem switched to the Availity Essentials authorization application to obtain prior authorization for Anthem patients. You will still be able to access your authorizations that were submitted via Interactive Care Reviewer (ICR) on the Availity app. In addition, Anthem had the Availity app set up to pin your past authorization to your app's dashboard.
Anthem is not fully migrating away from ICR yet. Anthem says that you are still able to access it for the following items below:
• Appeals
• Behavioral health authorizations and inquiries
• Federal Employee Program authorization and inquiries
• HealthLink authorizations and inquiries
• Medical specialty prescription authorizations and inquiries
Along with the move to the Availity Essential authorization application, come new CPT® codes that will require prior authorization that started June 1, 2023. Anthem states that new prior authorization codes will be needed for their commercial products, along with Medicaid and Medicare products. The list of new codes can be found below and on Anthem's website.
81309 - PIK3CA (phosphatidylinositol-4, 5-biphosphate 3-kinase, catalytic subunit alpha) (for example, colorectal and breast cancer) gene analysis, targeted sequence analysis (for example, exons 7, 9, 20)
81347 - SF3B1 (splicing factor [3b] subunit B1) (for example, myelodysplastic syndrome/acute myeloid leukemia) gene analysis, common variants (for example, A672T, E622D, L833F, R625C, R625L)
81348 – SRSF2 (serine and arginine-rich splicing factor 2) (for example, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (for example, P95H, P95L)
81357 – U2AF1 (U2 small nuclear RNA auxiliary factor 1) (for example, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variants (for example, S34F, S34Y, Q157R, Q157P)
81360 – ZRSR2 (zinc finger CCCH-type, RNA binding motif and serine/arginine-rich 2) (for example, myelodysplastic syndrome, acute myeloid leukemia) gene analysis, common variant(s) (for example, E65fs, E122fs, R448fs)
0117U – Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethytlglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-HPMA), quinolinic acid, kynurenic acid), LC-MS/MS, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain FoundationPI℠,Ethos Laboratories
0040U – BCR/ABL1 (t(9;22)) (for example, chronic myelogenous leukemia) translocation anaylsis, major breakpoint, quantitative
0049U – NPM1 (nucleophosmin) (for example, acute myeloid leukemia) gene analysis, quantitative
CPT copyright 2022 American Medical Association. All rights reserved.
