CommercialOctober 1, 2023
Medical Policies and Clinical Guidelines updates
Anthem Blue Cross and Blue Shield (Anthem) Medical Policies and Clinical Guidelines were reviewed for Indiana, Kentucky, Missouri, Ohio, and Wisconsin. The chart below contains the current Clinical Guidelines and Medical Policies reviewed, and the updates that were approved.
Policy or Guideline
| Information
| Effective date
|
DME.00032 Automated External Defibrillators for Home Use | Add to prior authorization | 1/1/2024 |
LAB.00003 In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays | Add to prior authorization | 1/1/2024 |
LAB.00011 Selected Protein Biomarker Algorithmic Assays | Add to prior authorization | 1/1/2024 |
LAB.00019 Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease | Add to prior authorization | 1/1/2024 |
LAB.00024 Immune Cell Function Assay | Add to prior authorization | 1/1/2024 |
LAB.00027 Selected Blood, Serum and Cellular Allergy and Toxicity Tests | Add to prior authorization | 1/1/2024 |
LAB.00035 Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis | Add to prior authorization | 1/1/2024 |
LAB.00036 Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus | Add to prior authorization | 1/1/2024 |
LAB.00037 Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS) | Add to prior authorization | 1/1/2024 |
LAB.00041 Machine Learning Derived Probability Score for Rapid Kidney Function Decline | Add to prior authorization | 1/1/2024 |
LAB.00046 Testing for Biochemical Markers for Alzheimer's Disease | Add to prior authorization | 1/1/2024 |
LAB.00048 Pain Management Biomarker Analysis | Add to prior authorization | 1/1/2024 |
GENE.00057 Gene Expression Profiling for Idiopathic Pulmonary Fibrosis | Add to prior authorization | 1/1/2024 |
MED.00004 Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Video microscopy, Ultrasonography) | Add to prior authorization | 1/1/2024 |
GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling | Add to prior authorization | 1/1/2024 |
SURG.00092 Implanted Devices for Spinal Stenosis | Add to prior authorization | 1/1/2024 |
LAB.00031 Advanced Lipoprotein Testing | Adding Code 0052U to prior authorization - Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of HDL, LDL, and VLDL by vertic | 1/1/2024 |
LAB.00033 Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer | Adding Code 0228U to prior authorization - Oncology (prostate), multianalyte molecular profile by photometric detection of macromolecules adsorbed on nanosponge array slides with machine learning, utilizing first morni | 1/1/2024 |
LAB.00015 Detection of Circulating Tumor Cell | Adding Code 0337U to prior authorization - Oncology (plasma cell disorders and myeloma), circulating plasma cell immunologic selection, identification, morphological characterization, and enumeration of plasma cells ba | 1/1/2024 |
LAB.00015 Detection of Circulating Tumor Cell | Adding Code 0091U to prior authorization - Oncology (colorectal) screening, cell enumeration of circulating tumor cells, utilizing whole blood, algorithm, for the presence of adenoma or cancer, reported as a positive o | 1/1/2024 |
LAB.00033 Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer | Adding Code 0359U to prior authorization - Oncology (prostate cancer), analysis of all prostate-specific antigen (PSA) structural isoforms by phase separation and immunoassay, plasma, algorithm reports risk of cancer | 1/1/2024 |
* Denotes prior authorization required
To view Medical Policies and utilization management guidelines, visit Anthem.com and select Providers, then select your state. Under Provider Resources, select Policies, Guidelines, and Manuals.
To help determine if prior authorization is needed for Anthem members, visit Anthem.com and select Providers, then select your state. Under Claims, select Prior Authorization. You can also call the phone number on the back of the member’s ID card.
To view medical policies and utilization management guidelines applicable to members enrolled in the Federal Employee Program® (FEP), visit fepblue.org and select Policies and Guidelines.
MULTI-BCBS-CM-038398-23
PUBLICATIONS: October 2023 Provider Newsletter
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