Guideline Updates Coverage and Clinical GuidelinesAnthem Blue Cross and Blue Shield | CommercialJuly 1, 2024

Coding update effective October 1, 2024

The following guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on May 9, 2024. Revisions have been made to the coding that may result in services previously considered medically necessary to now be considered not medically necessary for dates of service on or after October 1, 2024.

This guideline impacts all our products except for Anthem HealthKeepers Plus offered by HealthKeepers, Inc., Medicare Advantage, and the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program or FEP).

The services addressed in the guideline presented in this document will require authorization for all our products offered by HealthKeepers, Inc., except for the Anthem HealthKeepers Plus plan. Other exceptions are Medicare Advantage and the Blue Cross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or FEP®). A pre-determination can be requested for our Anthem PPO products.

Guideline

Code(s)

MED.00013
Parenteral Antibiotics for the Treatment of Lyme Disease

J0688, J0689, J0744, J2184, J2281

SURG.00011
Allogeneic, Xenographic, Synthetic, Bioengineered, and Composite Products for Wound Healing and Soft Tissue Grafting

65778, 65779, 65780, Q4290, V2790

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. Anthem Blue Cross and Blue Shield, and its affiliate HealthKeepers, Inc., serving all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123, are independent licensees of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

VABCBS-CM-060777-24

PUBLICATIONS: July 2024 Provider Newsletter