Coverage Guidelines effective January 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 January 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 August 22, 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:

 

• Gene Expression Profiling of Melanomas (GENE.00023)

 

• Growth Factors, Silver-based Products and Autologous Tissues for Wound Treatment, Soft Tissue Grafting and Regenerative Therapy (MED.00110)

 

• Surface Electromyography Devices for Seizure Monitoring (MED.00130)

 

• Percutaneous Vertebral Disc and Vertebral Endplate Procedures (SURG.00052)

 

• Non-Hematopoietic Adult Stem Cell Therapy (TRANS.00035)

 

• Inpatient Interfacility Transfers (CG-ANC-07)

 

• Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities (CG-DME-46)
• Noninvasive Home Ventilator Therapy for Respiratory Failure (CG-DME-47)

 

• Analysis of RAS Status (CG-GENE-02)