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Anthem BCBS Medical Policy Updates – June 2018
Click here to view the Anthem Blue Cross Blue Shield Medical Policy Updates »
June 2018 Medical Policy Updates:
- CG-ADMIN-02 Clinically Equivalent Cost Effective Services – Targeted Immune Modulators
- CG-DRUG-04 Use of Low Molecular Weight Heparin Therapy, Fondaparinux (Arixtra®), and Direct Thrombin Inhibitors in the Outpatient Setting
- CG-DRUG-05 Recombinant Erythropoietin Products
- CG-DRUG-08 Enzyme Replacement Therapy for Gaucher Disease
- CG-DRUG-09 Immune Globulin (Ig) Therapy
- CG-DRUG-16 White Blood Cell Growth Factors
- CG-DRUG-25 Intravenous versus Oral Drug Administration in the Outpatient and Home Setting
- CG-DRUG-34 Docetaxel (Docefrez™, Taxotere®)
- CG-DRUG-41 Zoledronic Acid
- CG-DRUG-46 Fosaprepitant (Emend®)
- CG-DRUG-48 Azacitidine (Vidaza®)
- CG-DRUG-49 Doxorubicin Hydrochloride Liposome Injection
- CG-DRUG-51 Romidepsin (Istodax®)
- CG-DRUG-53 Drug Dosage, Frequency, and Route of Administration
- CG-DRUG-60 Gonadotropin Releasing Hormone Analogs for the Treatment of Oncologic Indications
- CG-DRUG-62 Fulvestrant (FASLODEX®)
- CG-DRUG-73 Denosumab (Prolia®, Xgeva®)
- CG-DRUG-78 Antihemophilic Factors and Clotting Factors
- CG-LAB-12 Testing for Oral and Esophageal Cancer
- CG-MED-37 Intensive Programs for Pediatric Feeding Disorders
- CG-MED-45 Transrectal Ultrasonography
- CG-MED-50 Visual, Somatosensory and Motor Evoked Potentials
- CG-MED-71 Wound Care in the Home Setting
- CG-REHAB-05 Occupational Therapy
- CG-SURG-17 Trigger Point Injections
- CG-SURG-18 Septoplasty
- CG-SURG-30 Tonsillectomy for Children with or without Adenoidectomy
- CG-SURG-36 Adenoidectomy
- CG-SURG-40 Cataract Removal Surgery for Adults
- CG-SURG-46 Myringotomy and Tympanostomy Tube Insertion
- CG-SURG-55 Intracardiac Electrophysiological Studies (EPS) and Catheter Ablation
- DME.00022 Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)
- Documentation ^ Reporting Guidelines for Consultations
- DRUG.00046 Ipilimumab (Yervoy®)
- DRUG.00050 Eculizumab (Soliris®)
- DRUG.00067 Ramucirumab (Cyramza®)
- DRUG.00071 Pembrolizumab (Keytruda®)
- DRUG.00075 Nivolumab (Opdivo®)
- DRUG.00088 Atezolizumab (Tecentriq™)
- DRUG.00098 Lutetium Lu 177 dotatate (Lutathera®)
- DRUG.00104 Nusinersen (SPINRAZA™)
- DRUG.00107 Avelumab (Bavencio®)
- DRUG.00109 Durvalumab (IMFINZI™)
- DRUG.00110 Inotuzumab ozogamicin (Besponsa®)
- DRUG.00111 Guselkumab (Tremfya™)
- GENE.00001 Genetic Testing for Cancer Susceptibility
- GENE.00002 Preimplantation Genetic Diagnosis Testing
- GENE.00005 BCR-ABL Mutation Analysis
- GENE.00006 Epidermal Growth Factor Receptor (EGFR) Testing
- GENE.00007 Cardiac Ion Channel Genetic Testing
- GENE.00009 Gene-Based Tests for Screening, Detection and Management of Prostate Cancer
- GENE.00012 Preconceptional or Prenatal Genetic Testing of a Parent or Prospective Parent
- GENE.00016 Gene Expression Profiling for Colorectal Cancer
- GENE.00017 Genetic Testing for Diagnosis and Management of Hereditary Cardiomyopathies (including ARVD/C)
- GENE.00023 Gene Expression Profiling of Melanomas
- GENE.00025 Molecular Profiling for the Evaluation of Malignant Tumors
- GENE.00026 Cell-Free Fetal DNA-Based Prenatal Testing
- GENE.00031 Genetic Testing for PTEN Hamartoma Tumor Syndrome
- GENE.00038 Genetic Testing for Statin-Induced Myopathy
- GENE.00040 Genetic Testing for CHARGE Syndrome
- GENE.00045 Detection and Quantification of Tumor DNA Using Next Generation Sequencing in Lymphoid Cancers
- LAB.00003 In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays
- LAB.00011 Analysis of Proteomic Patterns
- LAB.00015 Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer
- LAB.00025 Topographic Genotyping
- MED.00024 Adoptive Immunotherapy and Cellular Therapy
- MED.00053 Non-Invasive Measurement of Left Ventricular End Diastolic Pressure (LVEDP) in the Outpatient Setting
- MED.00077 In-Vivo Analysis of Gastrointestinal Lesions
- MED.00081 Cognitive Rehabilitation
- MED.00087 Imaging Techniques for Screening and Identification of Cervical Cancer
- MED.00102 Ultrafiltration in Decompensated Heart Failure
- MED.00104 Non-invasive Measurement of Advanced Glycation Endproducts (AGEs) in the Skin
- MED.00111 Intracardiac Ischemia Monitoring
- MED.00112 Autonomic Testing
- MED.00118 Continuous Monitoring of Intraocular Pressure
- MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications
- MED.00124 Tisagenlecleucel (Kymriah™)
- OR-PR.00003 Microprocessor Controlled Lower Limb Prosthesis
- OR-PR.00004 Partial-Hand Myoelectric Prosthesis
- Overhead Expense For Office Based Surgery and Diagnostic Testing
- RAD.00001 Computed Tomography to Detect Coronary Artery Calcification
- RAD.00022 Magnetic Resonance Spectroscopy (MRS)
- RAD.00040 PET Scanning Using Gamma Cameras
- RAD.00043 Computed Tomography Scans with or without Computer Assisted Detection (CAD) for Lung Cancer Screening
- RAD.00054 MRI of the Bone Marrow
- RAD.00059 Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Embolization (TAE) for Malignant Lesions Outside the Liver except Central Nervous System (CNS) and Spinal Cord
- RAD.00066 Multiparametric Magnetic Resonance Imaging Fusion Targeted Prostate Biopsy
- SURG.00016 Stereotactic Radiofrequency Pallidotomy
- SURG.00022 Lung Volume Reduction Surgery
- SURG.00032 Transcatheter Closure of Patent Foramen Ovale and Left Atrial Appendage for Stroke Prevention
- SURG.00072 Lysis of Epidural Adhesions
- SURG.00075 Intervertebral Stabilization Devices
- SURG.00107 Prostate Saturation Biopsy
- SURG.00113 Artificial Retinal Devices
- SURG.00124 Carotid Sinus Baroreceptor Stimulation Devices
- SURG.00132 Devices for Maintaining Sinus Ostial Patency Following Sinus Surgery
- SURG.00137 Focused Microwave Thermotherapy for Breast Cancer
- SURG.00139 Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography
- SURG.00147 Synthetic Cartilage Implant for Metatarsophalangeal Joint Disorders
- SURG.00148 Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy
- SURG.00149 Percutaneous Ultrasonic Ablation of Soft Tissue
- TRANS.00016 Umbilical Cord Blood Progenitor Cell Collection, Storage and Transplantation
- TRANS.00025 Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection
- TRANS.00031 Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors
- Unit Frequency Maximums for Drugs and Biologic Substances
Added 6/28/2018;
- CG-ADMIN-02 Clinically Equivalent Cost Effective Services – Targeted Immune Modulators
- CG-BEH-01 Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome
- CG-DME-42 Non-implantable Insulin Infusion and Blood Glucose Monitoring Devices
- CG-DRUG-05 Recombinant Erythropoietin Products
- CG-DRUG-16 White Blood Cell Growth Factors
- CG-DRUG-64 FDA-Approved Biosimilar Products
- CG-DRUG-65 Tumor Necrosis Factor Antagonists
- CG-DRUG-66 Panitumumab (Vectibix®)
- CG-DRUG-68 Bevacizumab (Avastin®) for Non-Ophthalmologic Indications
- CG-DRUG-71 Ziv-aflibercept (Zaltrap®)
- CG-DRUG-72 Pertuzumab (Perjeta®)
- CG-DRUG-74 Canakinumab (Ilaris®)
- CG-DRUG-79 Siltuximab (Sylvant®)
- CG-DRUG-81 Tocilizumab (Actemra®)
- CG-DRUG-86 Ocriplasmin (Jetrea®) Intravitreal Injection Treatment
- CG-GENE-02 Analysis of KRAS Status
- CG-GENE-03 BRAF Mutation Analysis
- CG-LAB-09 Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain
- CG-MED-37 Intensive Programs for Pediatric Feeding Disorders
- CG-MED-38 Inpatient Admission for Radiation Therapy for Cervical or Thyroid Cancer
- CG-MED-59 Upper Gastrointestinal Endoscopy
- CG-REHAB-06 Speech-Language Pathology Services
- CG-SURG-40 Cataract Removal Surgery for Adults
- CG-SURG-48 Elective Percutaneous Coronary Interventions (PCI)
- CG-SURG-49 Endovascular Techniques (Percutaneous or Open Exposure) for Arterial Revascularization of the Lower Extremities
- CG-SURG-55 Intracardiac Electrophysiological Studies (EPS) and Catheter Ablation
- CG-SURG-61 Cryosurgical Ablation of Solid Tumors Outside the Liver
- CG-SURG-62 Radiofrequency Ablation to Treat Tumors Outside the Liver
- CG-SURG-72 Endothelial Keratoplasty
- CG-THER-RAD-02 Special Radiation Physics Consult and Treatment Procedure
- DRUG.00040 Abatacept (Orencia®)
- DRUG.00062 Obinutuzumab (Gazyva®)
- DRUG.00082 Daratumumab (DARZALEX™)
- DRUG.00118 Copanlisib (Aliqopa®)
- GENE.00011 Gene Expression Profiling for Managing Breast Cancer Treatment
- GENE.00044 Analysis of PIK3CA Status in Tumor Cells
- LAB.00031 Advanced Lipoprotein Testing
- MED.00090 Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders
- MED.00107 Medical and Other Non-Behavioral Health Related Treatments for Autism Spectrum Disorders and Rett Syndrome
- MED.00109 Corneal Collagen Cross-Linking
- MED.00112 Autonomic Testing
- MED.00119 High Intensity Focused Ultrasound (HIFU) for Oncologic Indications
- MED.00120 Voretigene neparvovec-rzyl (Luxturna™)
- MED.00122 Wilderness Programs
- RAD.00004 Peripheral Bone Mineral Density Measurement
- RAD.00059 Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Embolization (TAE) for Malignant Lesions Outside the Liver except Central Nervous System (CNS) and Spinal Cord
- SURG.00061 Presbyopia and Astigmatism-Correcting Intraocular Lenses
- SURG.00089 Balloon and Self-Expanding Absorptive Sinus Ostial Dilation
- SURG.00090 Radiofrequency Neurolysis and Pulsed Radiofrequency Therapy for Trigeminal Neuralgia (TGN)
- SURG.00115 Keratoprosthesis
- SURG.00126 Irreversible Electroporation (IRE)
- SURG.00132 Devices for Maintaining Sinus Ostial Patency Following Sinus Surgery
- SURG.00137 Focused Microwave Thermotherapy for Breast Cancer
- THER-RAD.00009 Intraocular Epiretinal Brachytherapy
- CG-BEH-15 Activity Therapy for Autism Spectrum Disorders and Rett Syndrome
- CG-DME-44 Electric Tumor Treatment Field (TTF)
- CG-DRUG-100 Interferon gamma-1b (Actimmune®)
- CG-DRUG-101 Ixabepilone (Ixempra®)
- CG-DRUG-102 Olaratumab (Lartruvo™)
- CG-DRUG-67 Cetuximab (Erbitux®)
- CG-DRUG-90 Intravitreal Treatment for Retinal Vascular Conditions
- CG-DRUG-91 Intravitreal Corticosteroid Implants
- CG-DRUG-92 Alpha-1 Proteinase Inhibitor Therapy
- CG-DRUG-93 Sarilumab (Kevzara®)
- CG-DRUG-94 Rituximab (Rituxan®) for Non-Oncologic Indications
- CG-DRUG-95 Belatacept (Nulojix®)
- CG-DRUG-96 Ado-trastuzumab emtansine (Kadcyla®)
- CG-DRUG-97 Rilonacept (Arcalyst®)
- CG-DRUG-98 Bendamustine Hydrochloride
- CG-DRUG-99 Elotuzumab (Empliciti™)
- CG-LAB-13 Skin Nerve Fiber Density Testing
- CG-MED-69 Inhaled Nitric Oxide
- CG-MED-70 Wireless Capsule Endoscopy for Gastrointestinal Imaging and the Patency Capsule
- CG-MED-72 Hyperthermia for Cancer Therapy
- CG-SURG-73 Balloon Sinus Ostial Dilation
- CG-SURG-74 Total Ankle Replacement
- CG-SURG-75 Transanal Endoscopic Microsurgical (TEM) Excision of Rectal Lesions
- CG-SURG-76 Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty
- CG-SURG-77 Refractive Surgery
- CG-SURG-79 Implantable Infusion Pumps
- CG-SURG-80 Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Embolization (TAE) for Treating Primary or Metastatic Liver Tumors
- CG-THER-RAD-03 Radioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy
- CG-THER-RAD-04 Selective Internal Radiation Therapy (SIRT) of Primary or Metastatic Liver Tumors
- CG-THER-RAD-07 Intravascular Brachytherapy (Coronary and Non-Coronary)
Click here to view the Anthem Blue Cross Blue Shield Medical Policy Updates »
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