Anthem BCBS Medical Policy Updates – July 2019

Click here to view the Anthem Blue Cross Blue Shield Medical Policy Updates »

 July 2019 Medical Policy Updates:

• Advanced Lipoprotein Testing
• After Hours, Emergency and Misc E^M Services
• Altered Auditory Feedback (AAF) Devices for the Treatment of Stuttering
• Ambulance Services: Ground; Non-Emergent
• Analysis of KRAS Status
• Analysis of Proteomic Patterns
• Ancillary Services for Pregnancy Complications
• Angiographic Evaluation and Endovascular Intervention for Dialysis Access Circuit Dysfunction
• Assistant Surgeons
• Auditory Brainstem Responses (ABRs) and Evoked Otoacoustic Emissions (OAEs) for Hearing Disorders
• Augmentative and Alternative Communication (AAC) Devices/Speech Generating Devices (SGD)
• Autologous Cellular Immunotherapy for the Treatment of Prostate Cancer
• Avelumab (Bavencio®)
• Axicabtagene ciloleucel (Yescarta®)
• Azacitidine (Vidaza®)
• Balloon Sinus Ostial Dilation
• Bendamustine Hydrochloride
• Bicompartmental Knee Arthroplasty
• Biomagnetic Therapy
• Bone-Anchored and Bone Conduction Hearing Aids
• Brentuximab Vedotin (Adcetris®)
• Bronchial Thermoplasty
• Cardiac Resynchronization Therapy (CRT) with or without an Implantable Cardioverter Defibrillator (CRT/ICD) for the Treatment of Heart Failure
• Cardiac Stress Testing with Electrocardiogram (ECG)
• Cardioverter Defibrillators
• Carfilzomib (Kyprolis®)
• Cervical Traction Devices for Home Use
• Chelation Therapy
• Circulating Tumor DNA Testing for Cancer (Liquid Biopsy)
• Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists
• Cochlear Implants and Auditory Brainstem Implants
• Cognitive Rehabilitation
• Cooling Devices and Combined Cooling/Heating Devices
• Corneal Collagen Cross-Linking
• Cosmetic and Reconstructive Services: Skin Related
• Cryoablation for Plantar Fasciitis and Plantar Fibroma
• Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer
• Diagnostic Fiberoptic Flexible Laryngoscopy
• Diagnostic Infertility Surgery
• Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell Transplantation
• Doppler-Guided Transanal Hemorrhoidal Dearterialization
• Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain
• Dynamic Low-Load Prolonged-Duration Stretch Devices
• Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography/ Videofluoroscopy)
• Electric Breast Pumps
• Electrical Nerve Stimulation, Transcutaneous, Percutaneous
• Endovascular Techniques (Percutaneous or Open Exposure) for Arterial Revascularization of the Lower Extremities
• Endovascular/Endoluminal Repair of Aortic Aneurysms, Aortoiliac Disease, Aortic Dissection and Aortic Transection
• External Ambulatory Event Monitors to Detect Cardiac Arrhythmias
• Extracorporeal Shock Wave Therapy for Orthopedic Conditions
• Fecal Analysis in the Diagnosis of Intestinal Disorders
• Fulvestrant (FASLODEX®)
• Functional Endoscopic Sinus Surgery (FESS)
• GAnalysis of PIK3CA Status in Tumor Cells
• Gene Expression Profiling for Managing Breast Cancer Treatment
• Genetic Testing for Cancer Susceptibility
• Genetic Testing for Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) Syndrome
• Genetic Testing for Colorectal Cancer Susceptibility
• Genetic Testing of an Individual’s Genome for Inherited Diseases
• High Resolution Anoscopy Screening for Anal Intraepithelial Neoplasia (AIN) and Squamous Cell Cancer of the Anus
• Hip Resurfacing
• Holter Monitors
• Hospital Beds and Accessories
• Hyperoxemic Reperfusion Therapy
• Immunizations
• Implantable Ambulatory Event Monitors and Mobile Cardiac Telemetry
• Implantable Middle Ear Hearing Aids
• Infant Home Apnea Monitors
• Injection Treatment for Morton’s Neuroma
• Interspinous Process Fixation Devices
• Intracytoplasmic Sperm Injection (ICSI)
• Investigational Criteria
• Ipilimumab (Yervoy®)
• Irreversible Electroporation (IRE)
• Ketogenic Diet for Treatment of Intractable Seizures
• Level of Care: Specialty Pharmaceuticals
• Magnetic Source Imaging and Magnetoencephalography
• Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging (MPRAGE MRI)
• Mandibular/Maxillary (Orthognathic) Surgery
• Mastectomy for Gynecomastia
• Maze Procedure
• Medical and Other Non-Behavioral Health Related Treatments for Autism Spectrum Disorders and Rett Syndrome
• Medical Necessity Criteria
• Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting
• Molecular Profiling for the Evaluation of Malignant Tumors
• Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis
• Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring
• Nerve Graft after Prostatectomy
• Nesiritide (Natrecor®)
• Neuromuscular Stimulation in the Treatment of Muscle Atrophy
• Nivolumab (Opdivo®)
• Non-implantable Insulin Infusion and Blood Glucose Monitoring Devices
• Obinutuzumab (Gazyva®)
• Open Treatment of Rib Fracture(s) Requiring Internal Fixation
• ORMicroprocessor Controlled Lower Limb Prosthesis
• ORUpper Extremity Myoelectric Orthoses
• Outpatient Cystourethroscopy
• Partial Left Ventriculectomy
• Pediatric Gait Trainers
• Pembrolizumab (Keytruda®)
• Penile Prosthesis Implantation
• Percutaneous and Endoscopic Spinal Surgery
• Percutaneous Ultrasonic Ablation of Soft Tissue
• Peripheral Nerve Blocks for Treatment of Neuropathic Pain
• Pertuzumab (Perjeta®)
• Pharmaceutical Waste
• Place of Service
• Prefabricated Oral Appliances for the Treatment of Obstructive Sleep Apnea
• Preventive Health Guidelines
• Protein Biomarkers for the Screening, Detection and Management of Prostate Cancer
• Pulmonary Rehabilitation
• Radiofrequency and Pulsed Radiofrequency Treatment of Trigger Point Pain
• Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia
• Ramucirumab (Cyramza®)
• Respiratory Viral Panel Testing in the Outpatient Setting
• Retinal Telescreening Systems
• Sacral Nerve Stimulation as a Treatment of Neurogenic Bladder Secondary to Spinal Cord Injury
• Selected Blood, Serum and Cellular Allergy and Toxicity Tests
• Short Tandem Repeat Analysis for Specimen Provenance Testing
• SpaceOAR® System
• SPECT/CT Fusion Imaging
• Speech-Language Pathology Services
• Standing Frames
• Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
• Surgical Treatment for Dupuytren’s Contracture
• Synthetic Cartilage Implant for Metatarsophalangeal Joint Disorders
• Tisagenlecleucel (Kymriah™)
• Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins as a Treatment of Atrial Fibrillation or Atrial Flutter (Radiofrequency and Cryoablation)
• Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention
• Transcatheter Heart Valve Procedures
• Transtympanic Micropressure for the Treatment of Ménière’s Disease
• Treatments for Urinary Incontinence
• Trigger Point Injections
• Ultrasound Bone Growth Stimulation
• Upper Gastrointestinal Endoscopy
• Use of Low Molecular Weight Heparin Therapy, Fondaparinux (Arixtra®), and Direct Thrombin Inhibitors in the Outpatient Setting
• Uterine Fibroid Ablation: Laparoscopic or Percutaneous Image Guided Techniques
• Vertical Expandable Prosthetic Titanium Rib
• Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders
• Wound Care in the Home Setting

Click here to view the Anthem Blue Cross Blue Shield Medical Policy Updates »

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