The following Anthem Blue Cross and Blue Shield (Anthem) medical polices and clinical guidelines were reviewed on November 11, 2021.


Determine if prior authorization is needed for an Anthem member by going to > select “Providers” > under “Claims” > select “Prior Authorization”, then select your state. Or, you may call the prior authorization phone number on the back of the member’s ID card.


Below are the new medical policies that have been approved.




Effective date


Wheelchair Mounted Robotic Arm

• The use of a wheelchair mounted robotic arm is considered Investigational & not medically necessary (INV&NMN) for all uses.



Wearable Devices for Stress Relief and Management

• Wearable devices for management, monitoring or prevention of stress and stress-related conditions are considered INV&NMN for all indications



Below are changes to the medical policies that have been approved.




Effective Date

SURG.00010 Treatments for Urinary Incontinence

• Added new criterion to INV&NMN statement on endovaginal cryogen-cooled, monopolar radiofrequency remodeling

• Added “as treatments for urinary incontinence” to Investigational & not medically necessary (INV&NMN) statement and removed wording on urinary incontinence.

New CPT category III code 0672T effective 01/01/2022 for Viveve procedure for urinary incontinence, considered INV&NMN; added CPT codes 53451-53454 effective 01/01/2022 for ProAct considered INV&NMN, replacing 0548T-0551T deleted 12/31/2021


SURG.00097 Scoliosis Surgery

Previously titled: Vertebral Body Stapling and Tethering for the Treatment of Scoliosis in Children and Adolescents

• Revised title

• Added “minimally invasive deformity correction system” to the Scope and Position Statement

No specific CPT code for ApiFix procedure, 22899 NOC already listed; added ICD-10-PCS codes for ApiFix considered INV&NMN


MED.00099 Navigational Bronchoscopy

Previously titled: Electromagnetic Navigational Bronchoscopy

• Revised title

• Removed the word “Electromagnetic” in the Position Statement



To view medical policies and 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®)), please visit > Policies & Guidelines.



Featured In:
February 2022 Anthem Provider News - Missouri