Coverage guidelines effective October 1, 2021

Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc., will implement the following new and revised coverage guidelines effective October 1, 2021.  These guidelines impact 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).  Furthermore, the guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on May 13, 2021.

 

The services addressed in these coverage guidelines here and in the attachment under "Article Attachments" on the right 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.

 

The guidelines addressed in this edition of Provider News are:

 

• Gene Expression Profiling for Idiopathic Pulmonary Fibrosis (GENE.00057)

 

• Selected Blood, Serum and Cellular Allergy and Toxicity Tests (LAB.00027)

 

• Machine Learning Derived Probability Score for Rapid Kidney Function Decline (LAB.00041)

 

• Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy, Ultrasonography) (MED.00004)

 

• Eye Movement Analysis Using Non-Spatial Calibration for the Diagnosis of Concussion (MED.00137)

 

• Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection (TRANS.00025)

 

1216-0721-PN-VA