CommercialDecember 1, 2023
Notice of Material Amendments to Contract and/or Change to Prior Authorization Requirements
Medical Policies and Clinical Guidelines updates — December 2023
The following Anthem Blue Cross and Blue Shield (Anthem) Medical Policies and Clinical Guidelines were reviewed for Indiana, Kentucky, Missouri, Ohio, and Wisconsin.
To view Medical Policies and Utilization Management Guidelines, go to anthem.com. Select Providers, then select your state. Under Provider Resources, select Policies, Guidelines & Manuals.
To help determine if prior authorization (PA) is needed for Anthem members, go to anthem.com. Select Providers, then 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 Blue Cross and Blue Shield Service Benefit Plan (commonly referred to as the Federal Employee Program®), visit fepblue.org and select Policies & Guidelines.
Below are the current Clinical Guidelines and/or Medical Policies that were reviewed, updated, and approved.
Policy/guideline | Information | Effective date |
MED.00002 Selected Sleep Testing Services | Add to PA | 3/1/2024 |
MED.00011 Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State | Add to PA | 3/1/2024 |
MED.00024 Adoptive Immunotherapy and Cellular Therapy | Add to PA | 3/1/2024 |
MED.00082 Quantitative Sensory Testing | Add to PA | 3/1/2024 |
MED.00092 Automated Nerve Conduction Testing | Add to PA | 3/1/2024 |
MED.00096 Low-Frequency Ultrasound Therapy for Wound Management | Add to PA | 3/1/2024 |
MED.00098 Hyperoxemic Reperfusion Therapy | Add to PA | 3/1/2024 |
MED.00101 Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s) | Add to PA | 3/1/2024 |
MED.00103 Automated Evacuation of Meibomian Gland | Add to PA | 3/1/2024 |
MED.00105 Bioimpedance Spectroscopy Devices for the Detection and Management of Lymphedema | Add to PA | 3/1/2024 |
MED.00111 Intracardiac Ischemia Monitoring | Add to PA | 3/1/2024 |
MED.00115 Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management | Add to PA | 3/1/2024 |
MED.00125 Biofeedback and Neurofeedback | Add to PA | 3/1/2024 |
MED.00131 Electronic Home Visual Field Monitoring | Add to PA | 3/1/2024 |
MED.00132 Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures | Add to PA | 3/1/2024 |
MED.00134 Non-invasive Heart Failure and Arrhythmia Management and Monitoring System | Add to PA | 3/1/2024 |
MED.00137 Eye Movement Analysis Using Non-Spatial Calibration for the Diagnosis of Concussion | Add to PA | 3/1/2024 |
MED.00141 High-volume Colonic Irrigation | Add to PA | 3/1/2024 |
RAD.00053 Cervical and Thoracic Discography | Add to PA | 3/1/2024 |
Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CM-038928-23
PUBLICATIONS: December 2023 Provider Newsletter
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