Coverage guidelines effective April 1, 2020

Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc., will implement the following new and revised coverage guidelines effective April 1, 2020.  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 November 7, 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.

Guidelines addressed in this edition of Provider News are:

• Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) (SURG.00028)

 

• Treatment of Varicose Veins (Lower Extremities) (SURG.00037)

 

• Transendoscopic Therapy for Gastroesophageal Reflux Disease, Dysphagia and Gastroparesis (SURG.00047)

 

• Vertebral Body Stapling and Tethering for the Treatment of Scoliosis in Children and Adolescents (SURG.00097)

 

• Paraesophageal Hernia Repair (CG-SURG-92)

 

• Whole Genome Sequencing, Exome Sequencing, Gene Panels, and Molecular Profiling (GENE.00052)