Anthem BCBS Medical Policy Updates – October 2018

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

 October 2018 Medical Policy Updates:

• ADMIN.00006 Review of Services for Benefit Determinations in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline
• Assistant Surgery Services
• Assistant Surgery Services/Code List
• CG-ADMIN-01 Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists
• CG-ADMIN-02 Clinically Equivalent Cost Effective Services – Targeted Immune Modulators
• CG-ANC-03 Acupuncture
• CG-DME-09 Continuous Local Delivery of Analgesia to Operative Sites using an Elastomeric Infusion Pump during the Post-Operative Period
• CG-DME-12 Home Phototherapy Devices for Neonatal Hyperbilirubinemia
• CG-DME-16 Pressure Reducing Support Surfaces – Groups 1, 2 & 3
• CG-DME-18 Home Oxygen Therapy
• CG-DME-22 Ankle-Foot & Knee-Ankle-Foot Orthotics (Braces)
• CG-DME-23 Lifting Devices for Use in the Home
• CG-DME-25 Seat Lift Mechanisms
• CG-DME-26 Back-Up Ventilators in the Home Setting
• CG-DME-41 Ultraviolet Light Therapy Delivery Devices for Home Use
• CG-DME-42 Non-implantable Insulin Infusion and Blood Glucose Monitoring Devices
• CG-DME-46 Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Lower Limbs
• CG-DRUG-03 Beta Interferons and Glatiramer Acetate for Treatment of Multiple Sclerosis
• CG-DRUG-08 Enzyme Replacement Therapy for Gaucher Disease
• CG-DRUG-09 Immune Globulin (Ig) Therapy
• CG-DRUG-107 Pharmacotherapy for Hereditary Angioedema
• CG-DRUG-14 Dihydroergotamine Mesylate (DHE) Injection for the Treatment of Migraine or Cluster Headaches in Adults
• CG-DRUG-19 Progesterone Therapy as a Technique to Prevent Preterm Delivery in High-Risk Women
• CG-DRUG-55 Elosulfase alfa (Vimizim®)
• CG-DRUG-58 Laronidase (Aldurazyme®)
• CG-DRUG-61 Gonadotropin Releasing Hormone Analogs for the Treatment of Non-Oncologic Indications
• CG-DRUG-74 Canakinumab (Ilaris®)
• CG-LAB-10 Zika Virus Testing
• CG-LAB-11 Screening for Vitamin D Deficiency in Average Risk Individuals
• CG-MED-02 Esophageal pH Monitoring
• CG-MED-08 Home Enteral Nutrition
• CG-MED-21 Anesthesia Services and Moderate (“Conscious”) Sedation
• CG-MED-24 Electromyography and Nerve Conduction Studies
• CG-MED-46 Ambulatory and Inpatient Video Electroencephalography
• CG-MED-51 Three-Dimensional (3-D) Rendering of Imaging Studies
• CG-MED-61 Preoperative Testing for Low Risk Invasive Procedures and Surgeries
• CG-MED-62 Resting Electrocardiogram Screening in Adults
• CG-MED-63 Treatment of Hyperhidrosis
• CG-MED-64 Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins as a Treatment of Atrial Fibrillation or Atrial Flutter (Radiofrequency and Cryoablation)
• CG-MED-66 Cryopreservation of Oocytes or Ovarian Tissue
• CG-REHAB-02 Outpatient Cardiac Rehabilitation
• CG-REHAB-04 Physical Therapy
• CG-REHAB-05 Occupational Therapy
• CG-REHAB-06 Speech-Language Pathology Services
• CG-REHAB-08 Private Duty Nursing in the Home Setting
• CG-SURG-15 Endometrial Ablation
• CG-SURG-28 Transcatheter Uterine Artery Embolization
• CG-SURG-37 Destruction of Pre-Malignant Skin Lesions
• CG-SURG-52 Level of Care: Hospital-Based Ambulatory Surgical Procedures, including Endoscopic Procedures
• CG-SURG-57 Diagnostic Nasal Endoscopy
• CG-SURG-58 Radioactive Seed Localization of Nonpalpable Breast Lesions
• CG-SURG-59 Vena Cava Filters
• CG-SURG-63 Cardiac Resynchronization Therapy (CRT) with or without an Implantable Cardioverter Defibrillator (CRT/ICD) for the Treatment of Heart Failure
• CG-SURG-90 Mohs Micrographic Surgery
• DME.00011 Electrical Stimulation as a Treatment for Pain and Related Conditions: Surface and Percutaneous Devices
• DME.00038 Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices
• Documentation and Reporting Guidelines for E/M Services
• Documentation Guidelines for Central Nervous System Assessments and Tests
• Documentation Guidelines for Psychotherapy Services
• DRUG.00110 Inotuzumab ozogamicin (Besponsa®)
• Endobronchial Valve Devices
• GENE.00033 Genetic Testing for Inherited Peripheral Neuropathies
• GENE.00047 Methylenetetrahydrofolate Reductase Mutation Testing
• Global Surgery
• Guidelines for Reporting Timed Units for Physical Medicine and Rehabilitation Services
• LAB.00028 Serum Biomarker Tests for Multiple Sclerosis
• LAB.00030 Measurement of Serum Concentrations of Tumor Necrosis Factor Antagonist Drugs and Antibodies to Tumor Necrosis Factor Antagonist Drugs
• Laboratory and Venipuncture Services
• MED.00057 MRI Guided High Intensity Focused Ultrasound Ablation of Uterine Fibroids
• MED.00082 Quantitative Sensory Testing
• MED.00089 Quantitative Muscle Testing Devices
• MED.00095 Anterior Segment Optical Coherence Tomography
• MED.00096 Low-Frequency Ultrasound Therapy for Wound Management
• MED.00099 Electromagnetic Navigational Bronchoscopy
• MED.00103 Automated Evacuation of Meibomian Gland
• MED.00125 Biofeedback and Neurofeedback
• Multiple Diagnostic Cardiovascular Procedures
• Multiple Diagnostic Imaging
• Powered Robotic Lower Body Exoskeleton Devices
• RAD.00001 Computed Tomography to Detect Coronary Artery Calcification
• RAD.00004 Peripheral Bone Mineral Density Measurement
• RAD.00037 Whole Body Computed Tomography Scanning
• RAD.00057 Near-Infrared Coronary Imaging and Near-Infrared Intravascular Ultrasound Coronary Imaging
• RAD.00062 Intravascular Optical Coherence Tomography (OCT)
• RAD.00064 Myocardial Sympathetic Innervation Imaging with or without Single-Photon Emission Computed Tomography (SPECT)
• Routine Obstetric Services
• �Rule of Eight� Reporting Guidelines for Physical Medicine and Rehabilitation Services
• Standby Services
• SURG.00008 Mechanized Spinal Distraction Therapy for Low Back Pain
• SURG.00011 Allogeneic, Xenographic, Synthetic and Composite Products for Wound Healing and Soft Tissue Grafting
• SURG.00067 Percutaneous Vertebroplasty, Kyphoplasty and Sacroplasty
• SURG.00082 Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedures of the Appendicular System
• SURG.00092 Implanted Devices for Spinal Stenosis
• SURG.00095 Viscocanalostomy and Canaloplasty
• SURG.00101 Suprachoroidal Injection of a Pharmacologic Agent
• SURG.00103 Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir)
• SURG.00104 Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis
• SURG.00114 Facet Joint Allograft Implants for Facet Disease
• SURG.00127 Sacroiliac Joint Fusion
• SURG.00128 Implantable Left Atrial Hemodynamic (LAH) Monitor
• SURG.00129 Oral, Pharyngeal and Maxillofacial Surgical Treatment for Obstructive Sleep Apnea
• SURG.00131 Lower Esophageal Sphincter Augmentation Devices for the Treatment of Gastroesophageal Reflux Disease (GERD)
• SURG.00135 Radiofrequency Ablation of the Renal Sympathetic Nerves
• SURG.00144 Occipital Nerve Block Therapy for the Treatment of Headache and Occipital Neuralgia
• TRANS.00035 Mesenchymal Stem Cell Therapy For Orthopedic Indications
• TRANS.00036 Stem Cell Therapy for Peripheral Vascular Disease

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

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