Coverage and Clinical Guidelines update (effective October 1, 2024)

Effective October 1, 2024, Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. will implement the following new and revised Coverage Guidelines. These guidelines impact 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). These guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on May 9, 2024.

Note The services addressed in the Coverage Guidelines presented in this document will require authorization for all our products offered by HealthKeepers, Inc., except for the Anthem HealthKeepers 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:

• LAB.00016 Fecal Analysis Panels in the Diagnosis of Intestinal Disorders
• RAD.00069 Absolute Quantitation of Myocardial Blood Flow Measurement

Fecal Analysis Panels in the Diagnosis of Intestinal Disorders (LAB.00016)

This revised Coverage Guideline addresses the use of fecal analysis for the diagnosis of intestinal disorders.

Fecal analysis panels are considered investigational and not medically necessary for all indications, including as a diagnostic test for the evaluation of intestinal dysbiosis, irritable bowel syndrome, malabsorption, or small intestinal overgrowth of bacteria.

The CPT^® codes associated with this revised Coverage Guideline are 0430U, 81599, and 89240.

Absolute Quantitation of Myocardial Blood Flow Measurement (RAD.00069)

This new Coverage Guideline addresses the use of absolute quantitation of myocardial blood flow (AQMBF), an imaging technique that can be used during various modalities of cardiac imaging including positron emission tomography (PET), cardiac magnetic resonance imaging (CMR), and single photon emission computed tomography (SPECT) scan imaging.

The use of absolute quantitation of myocardial blood flow testing is considered investigational and not medically necessary for all indications.

The CPT codes associated with this new Coverage Guideline are 78434, 0742T, 0899T, and 0900T.

These Coverage Guidelines are available for review on our website at anthem.com.