The medical policies, clinical utilization management (UM) guidelines and third-party criteria below were developed and/or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed.

 

Please share this notice with other members of your practice and office staff.

 

To view a guideline, visit our website

Updates:

Updates marked with an asterisk (*) indicate that the criteria may be perceived as more restrictive.

  • 00052 — Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling
  • Revised medically necessary indications
  • 00134 — Noninvasive Heart Failure and Arrhythmia Management and Monitoring System:
  • Revised investigational and not medically necessary indications
  • 00077 — Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques:
  • Expanded scope and revised investigational and not medically necessary indications
  • 00156 — Implanted Artificial Iris Devices
  • Revised investigational and not medically necessary indications
  • 00157 — Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis
  • Revised investigational and not medically necessary indications
  • 00112 — Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures):
  • Revised scope, and investigational and not medically necessary indications
  • CG-DME-07 — Augmentative and Alternative Communication (AAC) Devices with Digitized or Synthesized Speech Output
  • Revised medically necessary and not medically necessary indications
  • CG-REHAB-12 — Rehabilitative and Habilitative Services in the Home Setting: Physical Medicine/Physical Therapy, Occupational Therapy and Speech-Language Pathology
  • A new clinical UM guideline was created from content contained in CG-REHAB-04,
    CG-REHAB-05, CG-REHAB-06.
  • There are no changes to the guideline content.
  • Publish date is scheduled for December 8, 2020.
  • The following AIM Specialty Health® Clinical Appropriateness Guidelines have been revised and will be effective on December 6, 2020. To view AIM guidelines, visit the AIM Specialty Health page:
    • Interventional Pain Management (See August 16, 2020, version.)*
    • Chest Imaging (See August 16, 2020, version.)*
    • Oncologic Imaging (See August 16, 2020, version.)*
    • Sleep Clinical Guidelines (See August 16, 2020, version.)*

 

Medical policies

On August 13, 2020, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following medical policies applicable to Anthem. These guidelines take effect December 6, 2020.

 

Publish date

Medical Policy

Medical Policy title

New or revised

10/7/2020

*MED.00134

Non-invasive Heart Failure and Arrhythmia Management and Monitoring System

New

10/7/2020

*SURG.00156

Implanted Artificial Iris Devices

New

10/7/2020

*SURG.00157

Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis

New

9/1/2020

 

*GENE.00052

Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling

Revised

10/7/2020

*SURG.00077

Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques

Revised

10/1/2020

*SURG.00112

Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures)

Revised

 

Clinical UM guidelines

On August 13, 2020, the MPTAC approved the following clinical UM guidelines applicable to Anthem. These guidelines adopted by the medical operations committee for Medicare Advantage members on September 24, 2020. These guidelines take effect December 6, 2020.

 

Publish date

Clinical UM Guideline

Clinical UM Guideline title

New or revised

10/7/2020

*CG-DME-07

Augmentative and Alternative Communication (AAC) Devices with Digitized or Synthesized Speech Output

Revised

10/7/2020

CG-DME-25

Seat Lift Mechanisms

Revised

8/20/2020

CG-GENE-03

BRAF Mutation Analysis

Revised

8/20/2020

CG-SURG-83

Bariatric Surgery and Other Treatments for Clinically Severe Obesity

Revised

 

ABSCRNU-0190-20

 



Featured In:
December 2020 Anthem Connecticut Provider News