Policy Updates Medical Policy & Clinical GuidelinesCommercialMay 22, 2024

Medical Policies and Clinical Guidelines updates – June 2024

The following Anthem’s Medical Policies and Clinical Guidelines were reviewed for Indiana, Kentucky, Missouri, Ohio, and Wisconsin.

To view Medical Policies and Clinical Utilization Management Guidelines, go to anthem.com > select Providers > select your state > under Provider Resources > select Policies, Guidelines & Manuals.

To help determine if prior authorization is needed for Anthem members, go to anthem.com > select Providers > select your state > under Claims > select Prior Authorization. You can also call the prior authorization 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 > Policies & Guidelines.

Below are the current Clinical Guidelines or Medical Policies we reviewed, and updates were approved.

* Denotes prior authorization required

Policy/guideline

Information

Effective date

SURG.00019 Trans myocardial Revascularization

33140 Trans myocardial laser revascularization, by thoracotomy; (separate procedure) – Moving to Pre-Cert

9/1/2024

SURG.00032 Patent Foramen Ovale and Left Atrial Appendage Closure Devices for Stroke Prevention

33340 Percutaneous transcatheter closure of the left atrial appendage with endocardial implant, including fluoroscopy, transseptal puncture, catheter placement(s), left atrial angiography, left atrial appendage angiography, when performed, and radiological supervision and interpretation – Moving to Pre-Cert

9/1/2024

In Missouri (excluding 30 counties in the Kansas City area): Anthem Blue Cross and Blue Shield is the trade name of RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

MULTI-BCBS-CM-058742-24

PUBLICATIONS: June 2024 Provider Newsletter