Policy Updates Medical Policy & Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialJune 30, 2019

Un-adopted clinical guidelines effective June 1, 2019

(The following guidelines are no longer adopted.)

  • CG-DME-07-Augmentative and Alternative Communication (AAC) Devices/Speech Generating Devices (SGD)
  • CG-MED-70-Wireless Capsule Endoscopy for Gastrointestinal Imaging and the Patency Capsule
  • CG-MED-72-Hyperthermia for Cancer Therapy
  • CG-SURG-24-Functional Endoscopic Sinus Surgery (FESS)
  • CG-SURG-70-Gastric Electrical Stimulation
  • CG-SURG-73-Balloon Sinus Ostial Dilation
  • CG-SURG-76-Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty
  • CG-THER-RAD-04-Selective Internal Radiation Therapy (SIRT) of Primary or Metastatic Liver Tumors