Coverage Guidelines and Clinical Utilization Management Guidelines update

The Coverage Guidelines and Clinical Utilization Management (UM) Guidelines below, which are applicable to Anthem HealthKeepers Plus members, were developed or revised to support clinical coding edits. Note, several policies and guidelines were revised to provide clarification only and are not included. Existing precertification requirements have not changed. For markets with carved-out pharmacy services, the applicable listings below are informational only.

 

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To search for specific guidelines, visit https://mediproviders.anthem.com/va/Pages/medical.aspx

 

Coverage Guidelines  

 

On September 13, 2018, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Coverage Guidelines applicable to Anthem HealthKeepers Plus members.

 

Publish date	Coverage Guideline number	Coverage Guideline title	New or revised
10/17/2018	MED.00125	Biofeedback and Neurofeedback	New
10/17/2018	SURG.00103	Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)	Revised

 

 Clinical UM Guidelines

 

On September 13, 2018, the MPTAC approved the following Clinical UM Guidelines applicable to Anthem HealthKeepers Plus members. This list represents the guidelines adopted by the medical operations committee for the Government Business Division on September 27, 2018.

 

Publish date	Clinical UM Guideline number	Clinical UM Guideline title	New or Revised
10/17/2018	CG-DME-46	Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Lower Limbs	New
10/17/2018	CG-SURG-90	Mohs Micrographic Surgery	New
9/20/2018	CG-DRUG-94	Rituximab (Rituxan®) for Non-Oncologic Indications	Revised
10/17/2018	CG-DRUG-107	Pharmacotherapy for Hereditary Angioedema	Revised
9/20/2018	CG-SURG-40	Cataract Removal Surgery for Adults	Revised