Prior authorization requirement for Electrical Stimulation Device (HCPCS E0766)
This document notifies providers that Anthem is adding a prior authorization requirement for electrical stimulation devices used for cancer treatment (HCPCS E0766) and describes how providers can obtain detailed PA requirements. It affects Anthem-contracted and non-contracted providers submitting claims for this equipment.
Prior authorization requirements will be added for HCPCS code E0766 (electrical stimulation device used for cancer treatment).
Coverage Criteria
State and federal law, applicable contract language, and CMS guidelines — including definitions and any specific contract provisions or exclusions — take precedence over the precertification rules in this policy and must be considered first when determining coverage.
Effective August 1, 2018, Anthem is adding a prior authorization (PA) requirement for the electrical stimulation device billed with HCPCS code E0766 ("Electrical stimulation device used for cancer treatment; includes all accessories, any type").
Non‑compliance with the new PA requirements may result in claim denials. Detailed PA requirements and documentation instructions are available to contracted providers via the Provider Self‑Service Tool on Availity (WWW.Availity.com). Contracted and non‑contracted providers who cannot access Availity may call Provider Services using the number on the member's ID card for authorization requirements.
Codes Requiring Prior Authorization
| E0766 | Electrical stimulation device used for cancer treatment; includes all accessories, any type |
Provider Actions & Prior Authorization
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