Georgia Medical Policy and Clinical Guideline updates

The Medical Policy and Technology Assessment Committee (MPTAC) adopted the attached new and/or revised Medical Policies and Clinical Guidelines. Some may have expanded rationales, medical necessity indications, or criteria, and some may involve changes to policy position statements that might result in services that previously were covered being found to be either not medically necessary or investigational/not medically necessary. Clinical guidelines adopted by Anthem Blue Cross and Blue Shield (Anthem) and all the medical policies are available on the Anthem provider website. Select Georgia > Review Policies > View Medical Policies & Clinical UM Guidelines. Please note our medical policies now include not otherwise classified (NOC) codes to expedite the process of determining services that may require medical review. If you don’t have access to the internet, you may request a hard copy of a specific medical or behavioral health policy or clinical UM guideline by calling Provider Services at 800-241-7475 Monday to Friday, 8 a.m. to 7 p.m. or send written requests (specifying medical policy or guideline of interest, your name, and address where information should be sent) to:

Anthem Blue Cross and Blue Shield

Attention: Prior approval, mail code GAG009-0002

3350 Peachtree Road NE

Atlanta, GA 30326

Note: Any clinical guideline included in this standard MPTAC notification is only effective for Georgia if included on the Georgia Standard Adopted Clinical Guideline List unless there is a group-specific review requirement in which case it will be considered adopted for that group only and for the specific type of review required. Additionally, as part of the Pre-Payment Review program for commercial or Federal Employee Health Benefits Program (FEHBP) plans, clinical guidelines approved by MPTAC but not included in the Georgia Standard Adopted Clinical Guideline List may be used to review a provider’s claims when a provider’s billing practices are not consistent with other providers in terms of frequency or in some other manner or for provider education and are adopted for those purposes. 

To view the new and/or revised Medical Policies and Clinical Guidelines adopted by the MPTAC, open the attached document titled Georgia Medical Policy and Clinical Guideline updates January 1, 2023.

To view Medical Policies and UM Guidelines applicable to members enrolled in the Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program^® [FEP]), please visit fepblue.org. Scroll down and select Policies & Guidelines.