Coverage guidelines effective February 1, 2021

Anthem Blue Cross and Blue Shield in Virginia and our affiliate, HealthKeepers, Inc., will implement the following new and revised coverage guidelines effective February 1, 2021.  These guidelines impact all our products – with the exception of Anthem HealthKeepers Plus (Medicaid), Medicare Advantage, the Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan, 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 August 13, 2020.

 

The services addressed in these coverage guidelines here 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), Medicare Advantage, and the Anthem CCC Plus plan.  Please note that  FEP is excluded from these requirements as well.   A pre-determination can be requested for our PPO products.

If applicable, 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.

The guidelines addressed in this edition of Provider News are:

 

• Automated Evacuation of Meibomian Gland (MED.00103)

 

• Non-invasive Heart Failure and Arrhythmia Management and Monitoring System (MED.00134)

 

• Uterine Fibroid Ablation: Laparoscopic, Percutaneous or Transcervical Image Guided Techniques (SURG.00077)

 

• Implantation of Occipital, Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures) (SURG.00112)

 

• Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea or Snoring (SURG.00129)

 

• Implanted Artificial Iris Devices (SURG.00156)

 

• Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis (SURG.00157)

739-1120-PN-VA