Coverage guidelines effective September 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 September 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 February 20, 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), 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.

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)

 

• Low Intensity Therapeutic Ultrasound for the Treatment of Pain (DME.00041)

 

• Metagenomic Sequencing for Infectious Disease in the Outpatient Setting (GENE.00053)

• Paired DNA and Messenger RNA (mRNA) Genetic Testing to Detect, Diagnose and Manage Cancer (GENE.00054)

 

• Patent Foramen Ovale and Left Atrial Appendage Closure Devices for Stroke Prevention (SURG.00032)

 

• Surgical and Ablative Treatments for Chronic Headaches (SURG.00096)

 

• Microsurgical Procedures for the Treatment of Lymphedema (SURG.00154)

 

• Cryoneurolysis for Treatment of Peripheral Nerve Pain (SURG.00155)

 

• Mobile Device-Based Health Management Applications (CG-ANC-08)

 

• Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) (CG-SURG-107) (Previously SURG.00028)

473-0620-PN-VA