CommercialJune 25, 2025
Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — August 2025
The following Anthem Blue Cross and Blue Shield Medical Policies and Clinical Guidelines have been reviewed for care providers in Indiana, Kentucky, Missouri, Ohio, and Wisconsin. These updates will ensure the best ongoing care for our members.
Below are the new Medical Policies and/or Clinical Guidelines that have been approved.
* Denotes prior authorization required
Policy/Guideline | Information | Effective date |
*CG-MED-99 Intradialytic Parenteral Nutrition |
| 11/1/2025
|
*CG-MED-100 Surface Electrical Stimulation Devices for Headache and Migraine |
| 11/1/2025 |
*CG-SURG-126 Tibial Nerve Stimulation |
| 11/1/2025 |
*CG-SURG-127 Canaloplasty |
| 11/1/2025 |
Below are the current Clinical Guidelines and/or Medical Policies we reviewed, and updates were approved.
* Denotes prior authorization required
Policy/Guideline | Information | Effective date |
*CG-SURG-119 Treatment of Varicose Veins (Lower Extremities) |
| 4/16/2025 |
*LAB.00045 Selected Tests for the Evaluation and Management of Infertility
|
| 9/1/2025 |
*SURG.00011 Products for Wound Healing and Soft Tissue Grafting: Investigational
Previously Titled: Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting |
| 4/1/2025 |
*SURG.00047 Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia or Gastroparesis |
| 4/1/2025 |
*SURG.00158 Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain |
| 5/1/2025 |
For additional information:
- To view Medical Policies and Utilization Management Guidelines, go to https://anthem.com/provider > select Providers > Select your state > Under Provider Resources > Select Policies, Guidelines & Manuals.
- To help determine if prior authorization is needed for Anthem members, go to https://anthem.com/provider> Select Providers > Select your state > Under Claims > Select Prior Authorization. You can also call the prior authorization phone number on the back of the member’s ID card.
- To view Medical Policies and Utilization Management 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 > Policies & Guidelines.
Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-086393-25
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