Medical Policy and Clinical Guideline updates

The following new and revised Medical Policies and Clinical Guidelines were endorsed at the February 16, 2023, Medical Policy & Technology Assessment Committee (MPTAC) meeting. These, and all of Anthem Blue Cross and Blue Shield’s Medical Policies and Clinical Guidelines, are available at anthem.com. Select ForProviders. Under the Provider Resources heading, select Policies, Guidelines & Manuals. Select your state. Then, select View Medical Policies & Clinical UM Guidelines.

To view Medical Policies and Clinical 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 fepblue.org > Policies & Guidelines. 

Medical Policy updates

New Medical Policy effective August 1, 2023

The following policy is new:

• MED.00145 Digital Therapy Devices for Treatment of Amblyopia*

Revised Medical Policies effective August 1, 2023

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

• MED.00101 Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s)*
• SURG.00158 Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain*

Clinical Guideline updates

Revised Clinical Guideline effective August 1, 2023

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

• CG-MED-73 Hyperbaric Oxygen Therapy (Systemic/Topical)*