Policy Updates Medical Policy & Clinical GuidelinesCommercialDecember 1, 2021

Medical policy and clinical guideline updates - December 2021*

*Change to Prior Authorization Requirements


This following updates are for Anthem Blue Cross and Blue Shield (Anthem).

 

Below are updates to medical policies we originally published in the October 2021 edition of Provider News. The effective date has changed March 1, 2022 and prior authorization will be required.

 

Determine if prior authorization is needed for an Anthem member by going to anthem.com > select “Providers” > under “Claims” > select “Prior Authorization”, then select your state. Or, you may call the prior authorization phone number on the back of the member’s ID card.

 

*Prior authorization required

Name

Description

Effective Date

*GENE.00058

TruGraf Blood Gene Expression Test for Transplant Monitoring

TruGraf blood gene expression test is considered investigational and not medically necessary (INV&NMN) for monitoring immunosuppression in transplant recipients and for all other indications

Change to
3/1/2022

*LAB.00040

Serum Biomarker Tests for Risk of Preeclampsia

Serum biomarker tests to diagnosis, screen for, or assess risk of preeclampsia are considered INV&NMN

Change to
3/1/2022

*LAB.00042

Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy

Molecular signature testing to predict response to Tumor Necrosis Factor inhibitor (TNFi) therapy is considered INV&NMN for all uses, including but not limited to guiding treatment for rheumatoid arthritis

Change to
3/1/2022

OR-PR.00007

Microprocessor Controlled Knee-Ankle-Foot Orthosis

Outlines the MN and NMN criteria for the use of a microprocessor controlled knee-ankle-foot orthosis

Change to
3/1/2022

 

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 www.fepblue.org > Policies & Guidelines. 

 

1425-1221-PN-CNT

PUBLICATIONS: December 2021 Anthem Provider News - Indiana