Coverage and Clinical Guidelines update effective January 1, 2023

 Anthem Blue Cross and Blue Shield (Anthem) in Virginia and our affiliate HealthKeepers, Inc. will implement the following new and revised Coverage Guidelines effective January 1,2023. These guidelines impact all our products with the exception of Anthem HealthKeepers Plus, Medallion and Anthem CCC 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). These guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on August 11, 2022.

 

Special note:
The services addressed in ALL the coverage guidelines presented in this document and in the attachment under "Article Attachments" to the right will require authorization for all our products offered by HealthKeepers, Inc., with the exception of the Anthem HealthKeepers Plus, Medallion and Anthem HealthKeepers Plus, Commonwealth Coordinated Care Plus (Anthem CCC Plus). 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.

 

The guidelines addressed in this edition of Provider News are:

 

• Robotic Arm Assistive Devices (DME.00044)
• External Upper Limb Stimulation for the Treatment of Tremors (DME.00049)
• Remote Devices for Intermittent Monitoring of Intraocular Pressure (DME.00050)
• Artificial Intelligence-Based Software for Prostate Cancer Detection (LAB.00049)
• High Volume Colonic Irrigation (MED.00141)
• Nasal Valve Repair (SURG.00079)
• Hand Transplantation (TRANS.00040)
• Powered Wheeled Mobility Devices (CG-DME-31)
• Genotype Testing for Individual Genetic Polymorphisms to Determine Drug-Metabolizer Status (CG-GENE-11)

VABCBS-CM-006508-22