Coverage guidelines effective September 1, 2019
Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc., will implement the following new and revised coverage guidelines effective September 1, 2019. These guidelines impact all our products – with the exception of Anthem HealthKeepers Plus (Medicaid), the Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan, Medicare Advantage, 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 January 24, 2019.
The services addressed in these coverage guidelines in this section 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), the Anthem CCC Plus plan, Medicare Advantage, and the Federal Employee Program.
A pre-determination can be requested for our PPO products.
Services related to specialty pharmacy drugs (non-cancer related) require a Medical Necessity review, which includes site of care criteria, as outlined in the applicable coverage or clinical UM guideline listed below.
The guidelines address in this edition are:
- Preconception or Prenatal Genetic Testing of a Parent or Prospective Parent (GENE.00012)
- Genetic Testing of an Individual’s Genome for Inherited Diseases (GENE.00043)
- Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing (SURG.00152)
- Electric Tumor Treatment Field (TTF) (CG-DME-44)
- Janus Kinase 2, CALR and MPL Gene Mutation Assays (CG-GENE-01)
- Hyperthermia for Cancer Therapy (CG-MED-72)
- Temporomandibular Disorders (CG-SURG-09)
June 2019 Anthem Provider Newsletter - Virginia