Medical Policy and Clinical Utilization Management Guidelines updates

The following new and revised Medical Policies and Clinical Utilization Management Guidelines (CUMGs) were endorsed at the May 11, 2023 , Medical Policy & Technology Assessment Committee (MPTAC) meeting. These, and all Anthem Blue Cross and Blue Shield Medical Policies and CUMGs, 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 CUMGs 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

Archived Medical Policy effective October 1, 2023 

The following policy has been archived:

• GENE.00049 Circulating Tumor DNA Panel Testing (Liquid Biopsy) Content moved to GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling 

New Medical Policy effective October 1, 2023 

The following policy is new:

• SURG.00161 Nanoparticle-Mediated Thermal Ablation*

Revised Medical Policies effective October 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:

• DME.00011 Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices*
• GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling Moved content of GENE.00049 Circulating Tumor DNA Panel Testing (Liquid Biopsy) to this document. *
• MED.00004 Noninvasive Imaging Technologies for the Evaluation of Skin Lesions*
• SURG.00121 Transcatheter Heart Valve Procedures*
• SURG.00150 Leadless Pacemaker*

CUMG updates

Revised CUMG effective October 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-DME-31 Powered Wheeled Mobility Devices*
• CG-MED-73 Hyperbaric Oxygen Therapy (Systemic/Topical)*
• CG-SURG-95 Sacral Nerve Stimulation and Percutaneous or Implantable Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention*

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