Coverage guidelines effective January 1, 2022

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, 2022.  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 12, 2021.

 

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 Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan. A pre-determination can be requested for our PPO products. Please note that FEP is excluded from this requirement as well.

 

The guidelines addressed in this edition of Provider News are:

 

• Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring (DME.00043)

 

• TruGraf Blood Gene Expression Test for Transplant Monitoring (GENE.00058)

 

• Serum Biomarker Tests for Risk of Preeclampsia (LAB.00040)

 

• Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy (LAB.00042)

 

• Microprocessor Controlled Knee-Ankle-Foot Orthosis (OR-PR.00007)

 

• Ultraviolet Light Therapy Delivery Devices for Home Use (CG-DME-41)

 

• Electric Tumor Treatment Field (TTF) (CG-DME-44)

 

• Cardiac Resynchronization Therapy with or without an Implantable Cardioverter Defibrillator for the Treatment of Heart Failure (CG-SURG-63)

1345-1021-PN-VA