Medical Policy and Clinical Guideline updates

The following new revised Medical Policies and Clinical Guidelines were endorsed at the August 8, 2024, Medical Policy & Technology Assessment Committee (MPTAC) meeting. These, and all Anthem’s Medical Policies and Clinical Guidelines, are available at anthem.com. Select For Providers. 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 Policies effective January 1, 2025

The following policies are new:

• DME.00052 Brain Computer Interface Rehabilitation Devices*
• LAB.00051 Per- and Polyfluoroalkyl Substances (PFAS) Testing*
• MED.00150 Hepzato Kit™ (melphalan hepatic delivery system)*

Revised Medical Policies effective January 1, 2025

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:

• DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices*
• LAB.00026 Systems Pathology and Multimodal Artificial Intelligence Testing for Cancerous and Precancerous Conditions*
• MED.00134 Non-invasive Heart Failure and Arrhythmia Management and Monitoring Systems
• MED.00148 Gene Therapy for Metachromatic Leukodystrophy
• SURG.00032 Patent Foramen Ovale and Left Atrial Appendage Closure Devices*

Clinical Guideline updates

Adopted Clinical Guideline effective January 1, 2025

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

• CG-MED-97 Biofeedback and Neurofeedback*

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