Coverage guidelines effective July 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 July 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 February 11, 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 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:

• Cosmetic and Reconstructive Services of the Head and Neck (ANC.00008)

 

• Gene Expression Profiling for Bladder Cancer (GENE.00056)

 

• Cell-free DNA Testing to Aid in the Monitoring of Kidney Transplants for Rejection (LAB.00038)

 

• Pooled Antibiotic Sensitivity Testing (LAB.00039)

 

• Focal Laser Ablation for the Treatment of Prostate Cancer (SURG.00159)

 

• Uterine Transplantation (TRANS.00037)

 

• Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies (CG-SURG-78)

 

• Bone-Anchored and Bone Conduction Hearing Aids (CG-SURG-82)

 

1054-0421-PN-VA