Anthem BCBS Medical Policy Updates – May 2019

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

 May 2019 Medical Policy Updates:

• Adaptive Behavioral Treatment for Autism Spectrum Disorder
• Adenoidectomy
• Adoptive Immunotherapy and Cellular Therapy
• Allergy Immunotherapy (Subcutaneous)
• Ambulatory or Outpatient Surgery Center Procedures
• Analysis of KRAS Status
• Analysis of Proteomic Patterns
• Artificial Retinal Devices
• Automated External Defibrillators for Home Use
• Autonomic Testing
• Avelumab (Bavencio®)
• Axicabtagene ciloleucel (Yescarta®)
• Azacitidine (Vidaza®)
• Balloon and Self-Expanding Absorptive Sinus Ostial Dilation
• Balloon Dilation of the Eustachian Tubes
• BCR-ABL Mutation Analysis
• Bevacizumab (Avastin®) for Non-Ophthalmologic Indications
• Biofeedback and Neurofeedback
• Bioimpedance Spectroscopy Devices for the Detection and Management of Lymphedema
• Blinatumomab (Blincyto®)
• Bronchial Thermoplasty
• Cardiac Ion Channel Genetic Testing
• Carotid Sinus Baroreceptor Stimulation Devices
• Carotid, Vertebral and Intracranial Artery Stent Placement with or without Angioplasty
• Cell-Free Fetal DNA-Based Prenatal Testing
• Cetuximab (Erbitux®)
• CG-THRadioimmunotherapy and Somatostatin Receptor Targeted Radiotherapy
• Chelation Therapy
• Colonoscopy
• Computed Tomography to Detect Coronary Artery Calcification
• Continuous Monitoring of Intraocular Pressure
• Cosmetic and Reconstructive Services of the Head and Neck
• Cosmetic and Reconstructive Services of the Trunk and Groin
• Deep Brain, Cortical, and Cerebellar Stimulation
• Detection and Quantification of Tumor DNA Using Next Generation Sequencing in Lymphoid Cancers
• Detection of Circulating Tumor Cells in the Blood as a Prognostic Factor for Cancer
• Devices for Maintaining Sinus Ostial Patency Following Sinus Surgery
• Docetaxel (Docefrez™, Taxotere®)
• Doxorubicin Hydrochloride Liposome Injection
• Drug Dosage, Frequency, and Route of Administration
• Drug Screen Testing
• Durvalumab (IMFINZI™)
• Dynamic Low-Load Prolonged-Duration Stretch Devices
• Electric Tumor Treatment Field (TTF)
• External Infusion Pumps for the Administration of Drugs in the Home or Residential Care Settings
• Extracorporeal Shock Wave Therapy for Orthopedic Conditions
• Focused Microwave Thermotherapy for Breast Cancer
• Fulvestrant (FASLODEX®)
• Functional Electrical Stimulation (FES); Threshold Electrical Stimulation (TES)
• Fundus Photography
• Gene Expression Profiling for Coronary Artery Disease
• Gene Expression Profiling of Melanomas
• Gene-Based Tests for Screening, Detection and Management of Prostate Cancer
• Genetic Testing and Biochemical Markers for the Diagnosis of Alzheimer’s Disease
• Genetic Testing for Breast and/or Ovarian Cancer Syndrome
• Genetic Testing for Cancer Susceptibility
• Genetic Testing for Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) Syndrome
• Genetic Testing for CHARGE Syndrome
• Genetic Testing for Colorectal Cancer Susceptibility
• Genetic Testing for Diagnosis and Management of Hereditary Cardiomyopathies (including ARVD/C)
• Genetic Testing for DMD Mutations (Duchenne or Becker Muscular Dystrophy)
• Genetic Testing for Endocrine Gland Cancer Susceptibility
• Genetic Testing for Frontotemporal Dementia (FTD)
• Genetic Testing for Inherited Peripheral Neuropathies
• Genetic Testing for PTEN Hamartoma Tumor Syndrome
• Genetic Testing for Statin-Induced Myopathy
• Genetic Testing for TP53 Mutations (Li-Fraumeni Syndrome)
• Genetic Testing of an Individual’s Genome for Inherited Diseases
• Genicular Nerve Blocks and Ablation for Chronic Knee Pain
• Genotype Testing for Genetic Polymorphisms to Determine Drug-Metabolizer Status
• Gonadotropin Releasing Hormone Analogs for the Treatment of Oncologic Indications
• Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors
• Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma
• High Intensity Focused Ultrasound (HIFU) for Oncologic Indications
• Home Health
• Hyperthermia for Cancer Therapy
• Idiopathic Environmental Illness (IEI)
• Imaging Techniques for Screening and Identification of Cervical Cancer
• Implantable Infusion Pumps
• Implantable Left Atrial Hemodynamic (LAH) Monitor
• In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays
• Inhaled Nitric Oxide
• Inotuzumab ozogamicin (Besponsa®)
• Insulin Potentiation Therapy
• Intensive Programs for Pediatric Feeding Disorders
• Interferon gamma-1b (Actimmune®)
• Intervertebral Stabilization Devices
• Intracardiac Electrophysiological Studies (EPS) and Catheter Ablation
• Intracardiac Ischemia Monitoring
• Intracytoplasmic Sperm Injection (ICSI)
• Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography
• Intravenous versus Oral Drug Administration in the Outpatient and Home Setting
• In-Vivo Analysis of Gastrointestinal Lesions
• Ixabepilone (Ixempra®)
• Janus Kinase 2 (JAK2)V617F Gene Mutation Assay
• Kidney Transplantation
• Laboratory Testing as an Aid in the Diagnosis of Heart Transplant Rejection
• Leadless Pacemaker
• Level of Care: Advanced Radiologic Imaging
• Level of Care: Hospital-Based Ambulatory Surgical Procedures, including Endoscopic Procedures
• Level of Care: Outpatient Physical Therapy, Occupational Therapy, and Speech-Language Pathology Services
• Level of Care: Specialty Pharmaceuticals
• Locally Ablative Techniques for Treating Primary and Metastatic Liver Malignancies
• Lung Volume Reduction Surgery
• Lysis of Epidural Adhesions
• Magnetic Resonance Neurography
• Measurement of Serum Concentrations of Tumor Necrosis Factor Antagonist Drugs and Antibodies to Tumor Necrosis Factor Antagonist Drugs
• Medical and Other Non-Behavioral Health Related Treatments for Autism Spectrum Disorders and Rett Syndrome
• Mesenchymal Stem Cell Therapy For Orthopedic Indications
• Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting
• Modifier Rules
• Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures
• MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids
• MRI of the Bone Marrow
• Myringotomy and Tympanostomy Tube Insertion
• Non-invasive Measurement of Advanced Glycation Endproducts (AGEs) in the Skin
• Non-Invasive Measurement of Left Ventricular End Diastolic Pressure (LVEDP) in the Outpatient Setting
• Obinutuzumab (Gazyva®)
• Off-Label Drug and Approved Orphan Drug Use
• Olaratumab (Lartruvo™)
• ORPartial-Hand Myoelectric Prosthesis
• Ovarian and Internal Iliac Vein Embolization as a Treatment of Pelvic Congestion Syndrome
• Pancreas Transplantation and Pancreas Kidney Transplantation
• Panniculectomy and Abdominoplasty
• Percutaneous Ultrasonic Ablation of Soft Tissue
• PET Scanning Using Gamma Cameras
• Photocoagulation of Macular Drusen
• Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s)
• Pneumatic Compression Devices for Lymphedema
• Positional MRI
• Preconceptional or Prenatal Genetic Testing of a Parent or Prospective Parent
• Prefabricated and Prophylactic Knee Braces
• Preimplantation Genetic Diagnosis Testing
• Presbyopia and Astigmatism-Correcting Intraocular Lenses
• Private Duty Nursing in the Home Setting
• Prostate Multiparametric Magnetic Resonance Imaging
• Prostate Saturation Biopsy
• Respiratory Viral Panel Testing in the Outpatient Setting
• Romidepsin (Istodax®)
• Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence; Urinary Retention
• Screening and Assessment for Autism Spectrum Disorders and Rett Syndrome
• Scrotal Ultrasound
• SElectrothermal Shrinkage of Joint Capsules, Ligaments, and Tendons
• Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State
• Septoplasty
• Siltuximab (Sylvant®)
• Small Bowel, Small Bowel/Liver and Multivisceral Transplantation
• Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy
• Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lumbar-Sacral (LSO), and Lumbar
• Stereotactic Radiofrequency Pallidotomy
• SUnicondylar Interpositional Spacer
• Surgical and Ablative Treatments for Chronic Headaches
• Surgical and Minimally Invasive Treatments for Benign Prostatic Hyperplasia (BPH) and Other Genitourinary Conditions
• Surgical Strabismus Correction
• Surgical Treatment for Dupuytren’s Contracture
• Technologies for the Evaluation of Skin Lesions (including Dermatoscopy, Epiluminescence Microscopy, Videomicroscopy and Ultrasonography)
• Temporomandibular Disorders
• Testing for Oral and Esophageal Cancer
• THER-Intraocular Epiretinal Brachytherapy
• Tisagenlecleucel (Kymriah™)
• Tonsillectomy for Children with or without Adenoidectomy
• Topographic Genotyping
• Total Ankle Replacement
• Transanal Radiofrequency Treatment of Fecal Incontinence
• Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Embolization (TAE) for Malignant Lesions Outside the Liver except Central Nervous System (CNS) and Spinal Cord
• Transcatheter Arterial Chemoembolization (TACE) and Transcatheter Arterial Embolization (TAE) for Treating Primary or Metastatic Liver Tumors
• Transcatheter Heart Valve Procedures
• Transrectal Ultrasonography
• Treatment of Hyperhidrosis
• Treatments for Urinary Incontinence
• Trigger Point Injections
• Ultrafiltration in Decompensated Heart Failure
• Umbilical Cord Blood Progenitor Cell Collection, Storage and Transplantation
• Use of 3-D and 4-D Ultrasound in Maternity Care
• Use of Low Molecular Weight Heparin Therapy, Fondaparinux (Arixtra®), and Direct Thrombin Inhibitors in the Outpatient Setting
• Vacuum Assisted Wound Therapy in the Outpatient Setting
• Visual, Somatosensory and Motor Evoked Potentials
• Voretigene neparvovec-rzyl (Luxturna™)
• Wireless Capsule Endoscopy for Gastrointestinal Imaging and the Patency Capsule
• Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing
• Ziv-aflibercept (Zaltrap®)

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

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