Coverage Guidelines effective November 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 November 1, 2020.  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 May 14, 2020.

 

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), 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.

Guidelines addressed in this edition of Provider News are:

 

• Electrical Stimulation as a Treatment for Pain and Other Conditions: Surface and Percutaneous Devices (DME.00011)

 

• Electronic Positional Devices for the Treatment of Obstructive Sleep Apnea (DME.00042)

 

• Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography) (MED.00004)

 

• Electronic Home Visual Field Monitoring (MED.OO131)

 

• Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures (MED.OO132)

 

• Ingestion Event Monitors (MED.OO133)

 

• Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation (THER-RAD.OO012)

 

• Gene Mutation Testing for Solid Tumor Cancer Susceptibility and Management (CG-GENE-14)

559-0820-PN-VA