MedicaidDecember 31, 2018
Medical Policies and Clinical Utilization Management Guidelines update
Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.
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To search for specific policies or guidelines, visit http://www.empireblue.com/medicalpolicies/search.html.
Medical Policies
On September 13, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Empire BlueCross BlueShield HealthPlus (Empire).
Publish date |
Medical Policy number |
Medical Policy title |
New or revised |
10/17/2018 |
MED.00125 |
Biofeedback and Neurofeedback |
New |
10/17/2018 |
SURG.00103 |
Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) |
Revised |
Clinical UM Guidelines
On September 13, 2018, the MPTAC approved the following Clinical UM Guidelines applicable to Empire. This list represents the guidelines adopted by the medical operations committee for the Government Business Division on September 27, 2018.
Publish date |
Clinical UM Guideline number |
Clinical UM Guideline title |
New or Revised |
10/17/2018 |
CG-DME-46 |
Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Lower Limbs |
New |
10/17/2018 |
CG-SURG-90 |
Mohs Micrographic Surgery |
New |
9/20/2018 |
CG-DRUG-94 |
Rituximab (Rituxan®) for Non-Oncologic Indications |
Revised |
10/17/2018 |
CG-DRUG-107 |
Pharmacotherapy for Hereditary Angioedema |
Revised |
9/20/2018 |
CG-SURG-40 |
Cataract Removal Surgery for Adults |
Revised |
PUBLICATIONS: January 2019 Empire Provider Newsletter
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