The following new and revised medical policies and clinical guidelines were endorsed at the November 10, 2022, Medical Policy & Technology Assessment Committee (MPTAC) meeting. These, and all Anthem Blue Cross and Blue Shield medical policies and clinical guidelines, are available at anthem.com/provider > select state > scroll down and select See Policies and Guidelines.

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®]), visit www.fepblue.org > Policies & Guidelines. 

 

Medical policy updates

 

Archived medical policies effective April 1, 2023

The following policies have been archived:

  • GENE.00033 Genetic Testing for Inherited Peripheral Neuropathies (Note: Content merged into CG-GENE-13 Genetic Testing for Inherited Diseases.)
  • GENE.00037 Genetic Testing for Macular Degeneration (Note: Content merged into GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling and CG-GENE-13 Genetic Testing for Inherited Diseases.)
  • GENE.00038 Genetic Testing for Statin-Induced Myopathy (Note: Content merged into CG-GENE-13 Genetic Testing for Inherited Diseases.)
  • GENE.00039 Genetic Testing for Frontotemporal Dementia (FTD) (Note: Content merged into CG-GENE-13 Genetic Testing for Inherited Diseases.)

 

Revised medical policy effective April 1, 2023

The policy below was revised and might result in services that were previously covered but may now be found to be either not medically necessary and/or investigational:

  • GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling (Note: Moved content from GENE.00037 Genetic Testing for Macular Degeneration and CG-GENE-23 Genetic Testing for Heritable Cardiac Conditions into this document.) *

 

Clinical guideline updates

 

Archived clinical guidelines effective April 1, 2023

The following clinical guidelines have been archived:

  • CG-GENE-07 BCR-ABL Mutation Analysis (Note: Content merged into CG-GENE-14 Gene Mutation Testing for Cancer Susceptibility and Management.)
  • CG-GENE-17 RET Proto-oncogene Testing for Endocrine Gland Cancer Susceptibility (Content merged into CG-GENE-14 Gene Mutation Testing for Cancer Susceptibility and Management.)
  • CG-GENE-23 Genetic Testing for Heritable Cardiac Conditions (Note: Content merged into CG-GENE-13 Genetic Testing for Inherited Diseases and GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling.)

 

Revised clinical guidelines effective April 1, 2023

The following adopted guidelines were revised and might result in services that were previously covered but may now be found to be not medically necessary:

  • CG-GENE-13 Genetic Testing for Inherited Diseases (Note: Moved content from CG-GENE-23 Genetic Testing for Heritable Cardiac Conditions, GENE.00033 Genetic Testing for Inherited Peripheral Neuropathies, GENE.00037 Genetic Testing for Macular Degeneration [partial content], GENE.00038 Genetic Testing for Statin-induced Myopathy, and GENE.00039 Genetic Testing for Frontotemporal Dementia (FTD) into this document.) *
  • CG-GENE-14 Gene Mutation Testing for Cancer Susceptibility and Management (Note: Moved content from CG-GENE-07 BCR-ABL Mutation Analysis and CG-GENE-17 RET Proto-oncogene Testing for Endocrine Gland Cancer Susceptibility into this document.) *

 

* The applicable policy is attached to this article in PDF format.

MEBCBS-CM-014483-22



Featured In:
January 2023 Provider Newsletter - Maine