Anthem bcbs medical policy

Last UpdatedMarch 5, 2024

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Sep 27, 2023 · DME must meet the following definitions of “durable” and “medical equipment”: Durable. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands. Jan 3, 2024 · Description/Scope. Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0. Preventive services span a broad range of care for individuals of all ages. Discussion/General Information, References and Websites sections updated. You can access claim forms in our Forms Library. to 6 p. We offer deep discounts and one of the largest dental networks in the nation, along with ways to customize our plans for total flexibility. This document does not address upper gastrointestinal (GI) endoscopy in children, wireless capsule endoscopy, virtual endoscopy or in vivo analysis of gastrointestinal lesions via endoscopy. 17 Pelvic Floor Stimulation as a Treatment of Stay on top of your health with Individual and Family health insurance plans in Virginia. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage of these services as it applies to an individual member. updates. Save Time With Live Chat. ncbi. Anthem HealthKeepers medical plans offer healthcare coverage you and your family can rely on. Or send written requests (specifying medical policy or guideline of interest, your name and address to where Jan 3, 2024 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Learn about the factors, resources and criteria that impact your benefit plan and access the online tools for providers. Its mechanism of action is based upon the body’s production of different antibodies to an antigen depending on how the antigen is introduced into the body. 1-855-745-4397 (TTY/TDD: 711) Employer Plan: Contact your broker or consultant to learn more about Anthem plans. Behavioral Health Care (BHG) Chronic Care Guidelines (CCG) MCG and Anthem’s Medical Policies and Clinical UM Guidelines are available and can be requested by contacting Provider Services at 844-912-1226 or by emailing Anthem at ohiomedicaidprovider@anthem. Clinical Indications. . for 15 minutes through a loose-fitting facemask is considered a safe and effective, first-line treatment for acute attacks. Revised. 1. This technique provides added support and improves the healing ability of the eye. Select the desired Medical Policy or UM Guideline. Frequently affected sites include the trapezius, supraspinatus, infraspinatus, teres major, lumbar paraspinals, gluteus and pectoralis muscles. Status: Revised. Additionally, some benefit plans administered by the Plan such as some self-funded employer plans or governmental plans, may not utilize the Plan’s medical policy. Serial evaluation of fetal growth in multi-fetal pregnancy. Select “Request an ID card” and follow the instructions. Medical Policies. Anthem Blue Cross Cal MediConnect Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Medical supplies of an expendable nature such as incontinence pads, lambswool pads, catheters, ace bandages, elastic stockings The My Health Records feature in the Anthem Sydney app gives you access to your health data. Median SNOT-22 ranged from 19. Status: Reviewed. Select For Providers. ET, 8 a. ACA-NU-0411-22 February 2022 Medical Policies and Clinical Utilization Management Guidelines update This communication applies to the Medicaid and Medicare-Medicaid Plan (MMP) programs for Dec 1, 2023 · Medical Policy. These budget-friendly insurance options help lessen the financial impact of unexpected health care costs. Document #: ADMIN. Now you can supplement your benefits with Accident, Critical Illness, and Hospital Recovery plans. Find out how Anthem Blue Cross determines medical necessity and coverage for services, technologies and drugs. Behavioral Health Provider Resources. Click on “Customer Care”. Guideline #: CG-SURG-12. Providers have the opportunity to review Sep 27, 2023 · Medical technology is constantly evolving, and we reserve the right to review and update Medical Policy periodically. (November 16, 2021): pubmed. Diagnostic audio recording, with or without pulse oximetry to document sleep apnea. --An item is considered durable if it can withstand repeated use, that is, the type of item which could normally be rented. Choose from quality doctors and hospitals that are part of your plan with our Find Care tool. Find answers to frequently asked questions about health insurance, Medicare, and general account & plan information. This document addresses the criteria for implantation of a penile prosthesis, which is an established technique for treating erectile dysfunction (ED). 00002. Publish Date: 06/28/2023. Here, you will find Anthem’s provider manuals, Guidelines for clinical Utilization Management (UM) and medical policies. Anthem serves Medi-Cal recipients in these counties: Alpine, Amador, Calaveras, El Dorado, Fresno, Inyo, Kern, Kings, Los Angeles, Madera, Mono, Sacramento, San Francisco, Santa Clara, Tulare, and Tuolumne. com . The individual is less than 19 years old; or. Different states have different FAQs. We promote an effective healthcare strategy that reinforces innovation, integration, and collaboration. Jun 28, 2023 · Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. 15 Oscillatory Devices for the Treatment of Cystic Fibrosis and Other Respiratory Conditions. Prescription drug coverage, with some commonly-used drugs as low Anthem Blue Cross and Blue Shield, Anthem Blue Cross and HealthKeepers, Inc. Medically Necessary: Mohs micrographic Jan 3, 2024 · Temporomandibular disorders (TMD) is a collective term for temporomandibular joint dysfunction (TMJD), temporomandibular joint (TMJ) syndromes, and craniomandibular disorder (CMD), that includes a variety of medical and dental conditions involving the masticatory muscles and the temporomandibular joint, as well as contiguous tissue components. Apr 10, 2024 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Provider Manuals, Policies and Guidelines. com. Find the information you need about your health care benefits by chatting with an Anthem representative in real-time. Call: 833-901-1364 (TTY: 711) Learn more. Stay on top of your health with Individual and Family health insurance plans designed to fit your budget. Contact Customer Support by phone or Live Chat. The peripheral nerve stimulation indication is for adults with “severe intractable chronic pain of peripheral nerve origin. In some cases when you visit a doctor outside your plan, you may have to do this yourself. You can also supplement your benefits with Accident and Hospital Recovery plans. Learn more on how to get prepared. Sacral Nerve Stimulation Apr 1, 2024 · The Nalu Neurostimulation System (Nalu Medical, Carlsbad, California) was cleared by the FDA (K203547) in March 2021 for both spinal cord stimulation and peripheral nerve stimulation. The medical policies generally apply to all of the Plan’s fully-insured benefits plans, although some local variations may exist. Compare ratings, reviews, and costs of different providers and pharmacies. JAMA. Apr 1, 2024 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Jun 28, 2023 · Medical Policy. , skin, ligament, cartilage, etc. Sep 27, 2023 · Medically Necessary: An advanced radiologic imaging procedure in the hospital outpatient department is considered medically necessary when any of the following are present: The services being provided are only available in the hospital setting; or. Subject: Anesthesia Services and Moderate (“Conscious”) Sedation. Jan 3, 2024 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Anthem Blue Cross and Blue Shield Medicaid is committed to supporting you in providing quality care and services to the enrollees in our network. Actigraphy, including use of static charge sensitive beds. 05/12/2022. A surgical procedure for treating spinal stenosis by relieving pressure on the spinal cord. Neurogenic: Originating in the nervous system. Understanding Open Enrollment Through your Employer. AIN-NU-0293-21 July 2021 Medical drug benefit Clinical Criteria updates On May 15, 2020, June 18, 2020, August 21, 2020, September 24, 2020, November 20, 2020, December 22, 2020, and February 19, 2021, the Pharmacy and Therapeutics (P&T) Committee approved the Supplemental Insurance Plans. 50 – 64 years. PT. Clinical Guideline. Prioritize your mental wellbeing by getting regular exercise and a good night's sleep each night—small changes can make a big difference. Last Review Date: 05/11/2023. Jun 28, 2023 · Description. If you no longer qualify for Medicaid, we can help you find the right health coverage. Here are some steps to make sure your claim is processed Apr 10, 2024 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. MT, 7 a. These Medical Policies serve as guidelines for health care benefit coverage decisions, which may vary according to the different products and benefit plans offered by BCBSIL. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from the health plan. 5 cm) lesion (s) with or without biopsy. Anesthesia services include all services associated with the Stay on top of your health with Individual and Family health insurance plans in Indiana that are designed to fit your budget. Furthermore, the guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on August 12, 2021. ) substitutes in wound healing and surgical procedures. Get the information you need for your health insurance in Ohio. The most commonly performed type of ECCE surgery in the United States is phacoemulsification. Anthem Individual and Family plans can be an affordable option for you and your family. Description. MPTAC review. 52224. The lamina of the vertebra is removed or trimmed to widen the spinal canal and create more space for the spinal nerves. Last Review Date: 11/09/2023. 01. Stay on top of your health with Individual and Family health insurance plans in Kentucky that are designed to fit your budget. Medical policies are used by all plans and lines of business unless Federal or State law—as well as contract language, including definitions and specific contract provisions or exclusions—take precedence over a medical policy. This document addresses selected services for the diagnosis of sleep disorders including: “Nap” studies. Find a doctor or provider in the Anthem network that matches your plan type, location, and specialty. This document addresses indications for upper gastrointestinal (GI) endoscopy in adults. You can also supplement your benefits with Accident, Critical Illness, and Hospital Recovery plans. Same commitment to you. Sep 27, 2023 · This procedure involves the removal of the lens nucleus in one piece with an incision of approximately 10-14 mm, leaving the capsule in place. 65 and above. 5 at baseline to 10 at 6 months. Your mental health matters. The purpose of an orthosis (rigid or semi-rigid brace) is to support a weak or deformed body part, or to restrict or eliminate motion in a diseased or injured part of the body. For more, check out our programs and care options that Anthem Blue Cross and Blue Shield Medicaid (Anthem) is committed to supporting you in providing quality care and services to the members in our network. Those provisions will be considered first in determining eligibility for coverage before the Apr 1, 2022 · Medical Policies On November 11, 2021, the Medical Policy and Technology Assessment Committee (MPTAC) approved the following Medical Policies applicable to Anthem Blue Cross and Blue Shield (Anthem). As of January 1, 2024, the Empire BlueCross BlueShield and Empire BlueCross names are Anthem Blue Cross and Blue Shield and Anthem Blue Cross. Anthem Blue Cross and Blue Shield (Anthem) is committed to supporting you in providing quality care and services to the members in our network. These guidelines are used by Anthem Blue Cross to authorize, change or deny benefits for people with similar illnesses or conditions. On this page, you will find information for assessing coverage options, guidelines for clinical Utilization Management (UM), practice policies and support for delivering benefits to Sep 27, 2023 · 52214. Our FAQs are organized by state. Medicare Supplement and Medicare Advantage Plans: Mon-Fri, 8 a. Our health plans include coverage for doctor visits, hospital care, and mental health benefits, plus: $0 virtual care, 24/7 †. CT, 7 a. ”. Anthem’s medical plans offer healthcare coverage you and your family can rely on. Here’s how: Log in to your Anthem account. The most relevant clinical information is obtained Apr 10, 2024 · In the septoplasty group, mean VAS score ranged from 6. Learn how Jan 3, 2024 · Description/Scope. please contact your group administrator or your Anthem network representative. A Gold plan is a type of health insurance plan offered through the Marketplace, established by the Affordable Care Act (ACA), also known as Obamacare. You can access virtual care by logging in to your Anthem account or through your Sydney SM Health app. This document addresses the following three areas: reconstructive breast surgery, cosmetic surgeries designed to enhance the appearance of the breast and management of breast implants. Trusted by Medi-Cal members since 1994. Typically, your doctor or provider, especially if they’re in your plan, will submit the claim for you. Median PNIF ranged from 50-60 on the left and right sides respectively to 60-70 after 6 months. A peripheral Apr 10, 2024 · Subcutaneous allergy immunotherapy is an established treatment option in the United States designed to prevent or lessen an allergic reaction (Erekosima, 2014; Kim 2013; Mosges 2019). There is a wide array of uses for such products, including use as a cover for wounds related to disease processes (e. Reimbursement Policies. 21-855-715-5319 (TTY/TDD: 711) Medicare Part D Plans: Mon-Fri, 8 a. This page outlines the basis for reimbursement if the service is covered by an Anthem member’s benefit plan. Stem cell therapy involves the use of stem cells (usually in the form of an injection or infusion) to repair With so much to do, it’s easy to overlook one item that might prove crucial: ensuring that you will be covered if you need medical care while traveling. Find answers to frequently asked questions about claims, benefits, doctors, emergency care, and more. Keep in mind that determination of coverage under a member's plan does not necessarily ensure reimbursement. New name. Here you will find the Anthem provider manuals, guidelines for clinical Utilization Management (UM), medical policies and coding spotlights for common conditions. This document addresses trigger point injections. Most Blue Cross Blue Shield members can rest easy since Blue Cross Blue Shield coverage opens doors in all 50 states and is accepted by over 90 percent of doctors and specialists. Members may use the pre-tax funds from their HSA to pay for medical expenses, like copays and other costs, not covered by The policies contained in the FEP Medical Policy Manual are developed to assist in administering contractual benefits and do not constitute medical advice. Apr 10, 2024 · Peripheral nerve blocks are a proposed treatment for managing chronic neuropathic pain that results from peripheral neuropathy. Log in to Anthem. May 25, 2023 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. to 5 p. Please select your state to see helpful information about plans in your area. This document addresses the medical necessity of anesthesia services. Find medical policies and clinical UM guidelines for coverage decisions by Anthem Blue Cross. Subject: Preventive Health Guidelines. The Health Insurance Marketplace uses metal levels to categorize health insurance plans and provides consumers with a range of coverage options. Instead, please fax the request to Anthem Blue Cross Grievance and Appeals at fax # 818-234-2767 or 818-234-3824. MMS consists of a precise tissue-sparing surgical technique to remove and process skin tissue in successive stages. Visit Anthem today. Sydney Health is accessible for members who use the Engage Wellbeing app, but features are limited. Description/Scope. Prescription drug coverage, with some commonly-used drugs as low Jan 3, 2024 · Description/Scope. Sep 27, 2023 · Laminectomy: Also known as decompression. Check out key information about your member insurance card, including activating it digitally. Here you will find information about our Medical Policies and Clinical Utilization Management (UM) Guidelines. 00031 Apr 10, 2024 · Continuous interstitial glucose monitoring (CGM) device: A device applied to the skin that contains a sensor implanted into the skin to measure glucose concentrations in the interstitial fluid. Topographic brain mapping. This therapy involves the use of garments designed for various body parts and include mechanisms intended to compress specific body parts targeted for treatment. Sep 27, 2023 · Description. Evaluate a pelvic mass that has been detected clinically. g. Sep 27, 2023 · For the diagnosis of cluster headache, oxygen inhalation (100%) delivered at a rate of 7 to 10L/min. 35 – 49 years. Virtual care provides 24/7 availability with no appointment needed. Several national organizations produce evidence-based guidelines for these services. Find care near you from an in-network Anthem provider. Anthem Blue Cross and Blue Shield Healthcare Solutions (Anthem) is committed to supporting you in providing quality care and services to the members in our network. Backed by the power of blue (1 in 3 Americans carries a BCBS medical card*) we’re reimagining what’s possible for every moment of health. Publish Date: 01/03/2024. Learn about open enrollment and how to choose the right health insurance plan through work. They are not intended to replace or substitute for the independent medical judgment of a practitioner or other health care professional in the treatment of an individual member. Jun 28, 2023 · Subject: Penile Prosthesis Implantation. Compression devices may be used in clinics or can be purchased or rented for home use. This document addresses orthoses for the ankle-foot or the knee-ankle-foot. The Blue 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®). to 8 p. Peripheral nerve blocks are administered as an injection of a local anesthetic (such as bupivacaine or lidocaine) with or without adjuvants (such as steroids) near peripheral nerves or a nerve ganglion. 9 after 6 months. Added Note on medical records following section II in MN statement. Sep 27, 2023 · This document addresses uses of stem cell therapy for the prevention and treatment of health conditions, including but not limited to, peripheral vascular disease, and orthopedic, autoimmune, inflammatory, and degenerative conditions. Visit with a doctor from your mobile device, 24/7. Log in to find contact information specific to your area and plan. As the nation’s second largest health plan-owned company, Anthem Behavioral Health provides choice, innovation and access. Apr 10, 2024 · Description. Jun 28, 2023 · Applicable to Commercial HMO members in California: When a medical policy states a procedure or treatment is investigational, PMGs should not approve or deny the request. Note: Please see the following related documents for additional information: CG Back to Top How To Submit An Anthem Claim Yourself. 05 Low Intensity Pulsed Ultrasound Fracture Healing Device. to 7 p. Jan 3, 2024 · Clinical UM Guideline. You may also call 1-800-794-0838 to request a free paper copy of the guidelines used to determine your case. Find out if a prescription drug is covered by your plan. Those provisions will be considered first in determining eligibility for coverage before the At Anthem, we offer employers the full range of our expertise, experience, and innovative approach. This document addresses Mohs micrographic surgery (MMS), an outpatient procedure used in selective situations to treat malignant neoplasms of the skin. Our Utilization Management (UM) Guidelines, Medical Policies and Clinical Practice Sep 27, 2023 · Multiple medical specialty societies have published recommendations on the need for performing routine tests (for example, blood counts, chest x-ray and ECG), as part of the preoperative work-up before invasive procedures and surgeries considered low risk for postoperative complications in healthy individuals less than 65 years of age. Provider manuals and quick reference guides Please Select Your State. The provider manual is your key source for member benefits, program requirements and other administrative guidelines. to 7:00 p. Access Medical Policies and Clinical UM Guidelines. $0 preventive care §. This document addresses genicular procedures for knee pain. The following new Clinical Guideline was endorsed at the August 10, 2023, Medical Policy & Technology Assessment Committee (MPTAC) meeting. Dec 28, 2023 · This document addresses the use of devices that create compression for the treatment of lymphedema. ACA-NU-0440-22 May 2022 Medical Policies and Clinical Utilization Management Guidelines update This communication applies to the Medicaid, and Medicare-Medicaid Plan (MMP) programs for Anthem Jun 28, 2023 · Medical Policy. gov/34694343. Find FAQs By State. The four metal levels include Bronze, Silver, Gold A consumer-driven health plan (CDHP) is a high-deductible health insurance plan that allows individuals and families to set aside pre-tax money to help pay for qualified medical expenses. Dental Provider Resources. These guidelines take effect April 1, 2022. Modified bullet points in sections I and II of the MN statement related to pain and other diagnoses. You may be eligible for Medi-Cal if you’re in one of Jan 1, 2005 · To filter medical policies, begin typing the policy name or number: View All. Such devices may be used to create a record of glucose concentrations over time to allow analysis by a medical professional. Jun 28, 2023 · Medical Policy & Technology Assessment Committee (MPTAC) review. High-flow oxygen has been shown to abort the headache within several minutes. Members should contact their local customer Anthem Blue Cross Cal MediConnect Plan is a health plan that contracts with both Medicare and Medi-Cal to provide benefits of both programs to enrollees. Trigger points are small, circumscribed, hyperirritable foci in muscles, often found within a firm or taut band of skeletal muscle. com or use the Sydney Health app to start a Live Chat. Medi-Cal is California's Medicaid program. Frequently asked questions (FAQ) in Ohio. Anthem Blue Cross (Anthem) is committed to supporting you in providing quality care and services to the members in our network. These include genicular nerve blocks, genicular nerve radiofrequency ablation (also called genicular neurotomy, genicular denervation, or cooled radiofrequency therapy), and genicular artery embolization for the management of knee pain. , diabetes, peripheral artery and venous disease, recessive dystrophic epidermolysis bullosa), coverage or support of surgical and other Dec 28, 2023 · Inclusion or exclusion of a procedure, diagnosis or device code(s) does not constitute or imply member coverage or provider reimbursement policy. The individual requires an obstetrical observation; or. We want to help physicians, facilities and other health care professionals submit claims accurately. 09 Transcutaneous Electrical Nerve Stimulation. For Mental Health Month, we’re here to remind you that your mental health is a crucial part of your overall health. Prescription drug coverage, with some commonly-used drugs as low as $0 ¶. In addition to the active and pending Medical Policies, BCBSIL has included policies which are under development or being revised. Jan 1, 2022 · If you don’t have access to the internet, you may request a hard copy of a specific medical or behavioral health policy or clinical UM guideline by calling provider services at (800) 241-7475 Monday–Friday from 8:00 a. m. A good choice for: Flu-like symptoms, allergies, fever, sinus infection, diarrhea, eye infection, skin infection, rash, urinary tract infection (UTI). You can request a new Anthem ID card by calling 800-676-BLUE (2583) or print a new card online. Talk to a health plan consultant: 833-828-6962 (TTY: 711) Mon-Fri, 8 am to 8 p. 28 at baseline to 2. nih. Learn how to access, interpret, and request hard copies of these documents for informational purposes. Plus, receive estimated costs based on your plan and where you live. nlm. Are you an Anthem member? Explore Anthem member resources including billing, claims, ID cards, urgent care, and more. Reconstructive breast surgery refers to surgical procedures to rebuild the contour of the breast, along with the nipple and areola if desired. Jan 3, 2024 · Medically Necessary: Maternity ultrasound is considered medically necessary for any of the following: Estimate gestational age for individuals with uncertain clinical dates. Apr 1, 2024 · This document addresses the use of soft tissue (e. Members can log in to start a Live Chat with us. Anthem health plans include coverage for doctor visits, hospital care, and mental health benefits, plus: $0 virtual care, 24/7 †. Preventive care can help avoid common illnesses & protect your overall health. Find answers to questions about benefits, claims, prescriptions, and more. This, and all Anthem Blue Cross and Blue Shield’s Medical Policies and Clinical Guidelines, are available at anthem. This will not impact your coverage, access to care, or level of support. Anthem Blue Cross Medical Policies and Clinical Utilization Management Guidelines update Page 3 of 3 Publish date Medical Policy # Medical Policy title New or revised 5/20/2021 TRANS. CDHPs are HDHPs paired with HSAs. Median NOSE score ranged from 70 at baseline to 40 after 6 months. 1 Caughey AB, Krist AH, Wolff TA, et al: USPSTF Approach to Addressing Sex and Gender When Making Recommendations for Clinical Preventive Services. Health Resources. Note: Please see the following related documents for Jun 28, 2023 · Description. are Qualified Health Plans that in certain geographic areas offer some health plans with a $0 (or $1 in Maine and Connecticut) premium option after subsidy is applied through the Health Insurance Marketplace or your state exchange. and. Guideline #: CG-MED-21. pj pi bp rq qw th jq zx rd lc