The following guideline was among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on February 17, 2022. Revisions have been made to the coding which may result in services previously considered medically necessary to now be considered NOT medically necessary for dates of service (DOS) on or after August 1, 2022.  This guideline impacts all our products – with the exception of Anthem HealthKeepers Plus (Medicaid), Medicare Advantage, the Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan, and the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program or FEP).

 

The services addressed in this guideline will require authorization for all of our HealthKeepers, Inc. products with the exception of Anthem HealthKeepers Plus (Medicaid), Medicare Advantage and the Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan. A pre-determination can be requested for our PPO products. Please note that FEP is excluded from this requirement as well.

 

Guideline           

Code(s)

CG-GENE-14

81176, 81206, 81207, 81208, 81233, 81236, 81310, 81315, 81334, 81347, 81357, 81360

 

2069-0522-PN-VA



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May 2022 Anthem Provider News - Virginia