State & FederalMedicaidAugust 17, 2018

Medical Policies update

On January 25, 2018, the medical policy and technology assessment committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem). These policies were developed or revised to support clinical coding edits. Several policies were revised to provide clarification only and are not included in the below listing.

 

The Medical Policies were made publicly available on our provider website on the effective date listed. To search for specific policies, visit http://www.anthem.com/cptsearch_shared.html.

 

Please note:

  • Starting July 1, 2018, AIM Specialty Health® Cardiology and Radiation Oncology Guidelines are utilized for clinical reviews.
  • For markets with carved-out pharmacy services, the applicable listings below are informational only.

 

Existing precertification requirements have not changed. Please share this notice with other members of your practice and office staff.

 

Publish date

Medical Policy number

Medical Policy title

New or revised

2/28/2018

DRUG.00116

Vestronidase alfa (Mepsevii™)

New

2/28/2018

DRUG.00046

Ipilimumab (Yervoy®)

Revised

2/28/2018

DRUG.00075

Nivolumab (Opdivo®)

Revised

2/28/2018

DRUG.00077

Monoclonal Antibodies to Interleukin-17A

Revised

2/1/2018

DRUG.00080

Monoclonal Antibodies for the Treatment of Eosinophilic Conditions

Revised

2/28/2018

DRUG.00082

Daratumumab (DARZALEX™)

Revised

2/28/2018

DRUG.00099

Cerliponase Alfa (Brineura™)

Revised

2/28/2018

GENE.00028

Genetic Testing for Colorectal Cancer Susceptibility

Revised

2/1/2018

GENE.00029

Genetic Testing for Breast and/or Ovarian Cancer Syndrome

Revised

2/28/2018

GENE.00035

Genetic Testing for TP53 Mutations

Revised

2/28/2018

MED.00100

Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

Revised

2/1/2018

SURG.00011

Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting

Revised

2/1/2018

SURG.00098

Mechanical Embolectomy for Treatment of Acute Stroke

Revised

2/28/2018

SURG.00145

Mechanical Circulatory Assist Devices (Ventricular Assist Devices, Percutaneous Ventricular Assist Devices and Artificial Hearts)

Revised

 

ANVPEC-0669-18 July 2018

PUBLICATIONS: August 2018 Anthem Provider Newsletter - NV