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Anthem Jan 1, 2021 Policy Updates / Medical Policy & Clinical Guidelines
January 11, 2021The following Anthem Blue Cross and Blue Shield (Anthem) medical polices and clinical guidelines for Indiana, Kentucky, Missouri, Ohio and Wisconsin.
NOTE *Precertification required
| Title | Information | Effective Date |
| GENE.00055 Gene Expression Profiling for Risk Stratification of Inflammatory Bowel Disease (IBD) Severity |
• Gene expression profiling for risk stratification of inflammatory bowel disease (IBD) severity, including use of PredictSURE IBD, is considered Investigational and not medically necessary (INV&NMN) for all indications. CPT PLA code 0203U (effective 10/01/2020) will be considered INV&NMN; also listed NOC codes 81479, 81599 considered NMN when specified as this test. |
4/1/2021 |
| LAB.00037 Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS) |
• Serological testing for biomarkers of irritable bowel syndrome (for example, CdtB and anti-vinculin), using tests such as, IBSDetex, ibs-smart or IBSchek, is considered INV&NMN for screening, diagnosis or management of irritable bowel syndrome, and for all other indications. CPT PLA codes 0164U (effective 04/01/2020) and 0176U (effective 07/01/2020) will be considered INV&NMN. |
4/1/2021 |
| *CG-GENE-21 Cell-Free Fetal DNA-Based Prenatal Testing |
• Content moved from GENE.00026 • INV&NMN changed to NMN as a result of MP to CUMG transition • Re-formatted clinical indications |
12/16/2020 |