Medical Policy and Clinical Guideline updates

The following new revised Medical Policies and Clinical Guidelines and all other Anthem Medical Policies and Clinical Guidelines are available at https://anthem.com. Select For Providers. Select your state. Under the Resources heading, select 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 https://fepblue.org > Policies & Guidelines.

New Medical Policies effective August 1, 2025:

• DME.00053 Home Video‑Assisted Robotic Rehabilitation Systems*
• MED.00151 Gene Therapy for Aromatic L‑Amino Acid Decarboxylase Deficiency*
• MED.00152 Outpatient Intravenous Insulin Therapy*
• SURG.00165 Histotripsy*

Revised Medical Policies effective August 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*
• MED.00057 MRI Guided High Intensity Focused Ultrasound Ablation for Non‑Oncologic Indications*
• SURG.00011 Products for Wound Healing and Soft Tissue Grafting: Investigational*
• SURG.00155 Cryosurgery of Peripheral Nerves*
• TRANS.00033 Heart Transplantation*

Revised Clinical Guidelines effective August 1, 2025:

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‑SURG‑119 Treatment of Varicose Veins (Lower Extremities)*
• CG‑SURG‑123 Autologous Fat Grafting and Injectable Soft Tissue Fillers*

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