The following Anthem Blue Cross and Blue Shield medical polices and clinical guidelines were reviewed on November 8, 2018 for Indiana, Kentucky, Missouri, Ohio and Wisconsin.

 

New Medical Policy

Effective May 1, 2019

MED.00126 Fractional Exhaled Nitric Oxide and Exhaled Breath Condensate Measurements for Respiratory Disorders

The measurement of exhaled nitric oxide is considered INV&NMN in the diagnosis and monitoring of asthma and other respiratory disorders

·        The measurement of exhaled breath condensate is considered INV&NMN in the diagnosis and monitoring of asthma and other respiratory disorders

 

 

The below current Clinical Guidelines and/or Medical policies were reviewed and updates were approved

*requires precertification

 

 

Title

 

Change

Effective date

CG-BEH-01 Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome

• Added tests for metabolic markers in the blood, urine, tissue, or other biologic materials (also known as metabolomics), including but not limited to Amino Acid Dysregulation Metabotype (ADDM) testing as NMN

 

- Added existing CPT PLA code 0063U (NMN); added new CPT psych testing codes 96112, 96113, 96121, 96130-96133, 96136-96139, 96146 replacing 96101-96103, 96111, 96118-96120 & new CPT 81171, 88172 for AFF2 gene replacing Tier 2 eff 01/01/19

5/1/2019

CG-MED-79 Diaphragmatic/Phrenic Nerve Stimulation and Diaphragm Pacing Systems

• Content moved from MED.00100

• No change to clinical indications

1/3/2019

CG-MED-80 Positron Emission Tomography (PET) and PET/CT Fusion*

• Content moved from RAD.00002

• No change to clinical indications

1/3/2019

CG-SURG-27 Sex Reassignment Surgery*

• Added criteria requiring referral letters to mastectomy MN statement

5/1/2018

 



Featured In:
February 2019 Anthem Ohio Provider Newsletter