Medical Policy and Clinical Guideline updates are available on our provider website

The following new and revised medical policies and clinical guidelines were endorsed at the November 10, 2022, Medical Policy & Technology Assessment Committee (MPTAC) meeting. These, and all Anthem Blue Cross and Blue Shield’s Medical Policies and Clinical Guidelines, are available at anthem.com. Select ForProviders. Under the Provider Resources heading, select Policies, Guidelines & Manuals. Select your state. Then, select View Medical Policies & Clinical UM Guidelines.

To view Medical Policies and Clinical 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]), visit www.fepblue.org > Policies & Guidelines. 

Medical Policy updates

New Medical Policy effective May 1, 2023

The following policy is new:

• 00143 Ingestible Devices for the Treatment of Constipation

Revised Medical Policies effective May 1, 2023

The policies below were revised and might result in services that were previously covered but may now be found to be either not medically necessary and/or investigational:

• 00130 Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring
• 00097 Scoliosis Surgery

Clinical Guideline updates

Revised Clinical Guideline effective May 1, 2023

The following adopted guideline was revised and might result in services that were previously covered but may now be found to be not medically necessary:

• CG-DME-31 Powered Wheeled Mobility Devices