Immediate Care: Anthem Bariatric Medical Policy

Friday, July 15, 2022

Anthem Bariatric Medical Policy

Some policies address procedures and services that are considered to be part of. Blue Cross of California is Anthem BCBS trade name which means the criteria for the surgery will be the same.

Anthem Bcbs Requirements For Weight Loss Surgery

View our medical dental medication and reimbursement policies.

Anthem bariatric medical policy. There are several factors that impact whether a service or procedure is covered under a members benefit plan. The use of surface electromyography sEMG devices for seizure monitoring is considered Investigational and Not medically necessary INVNMN Revised medical necessity MN indications to include the use of a circulating tumor DNA ctDNA test to detect mutations of the PIK3CA gene. This medical policy has been revised and will be effective January 1 2019.

Publish date Medical Policy number Medical Policy title New or revised 9252019 MED00130 Surface Electromyography Devices for Seizure Monitoring New. The following policy has been archived. Conversion A second bariatric procedure that changes the bariatric approach from the index procedure to a different type of procedure eg sleeve gastrectomy or adjustable gastric band converted to Rouxen- -Y.

These guidelines address hundreds of medical issues including diagnostic and therapeutic procedures injectable drugs and durable medical equipment. Medical policies and clinical utilization management UM guidelines are two resources that help us determine if a procedure is medically necessary. Our medical policies help us determine what technology procedure treatment supply equipment drug or other service well cover.

However even when a policy excludes the weight loss surgery if BCBS can be shown these kinds of surgeries are medically important for ones health the exclusion can be appealed. RAD00062 - Intravascular Optical Coherence Tomography OCT New medical policies effective January 1 2021. Below are new medical policies or clinical guidelines.

These guidelines are available to you as a reference when interpreting claim decisions. 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. Anthems full policy on weight loss surgery insurance coverage is no longer available online.

These documents are available to you as a reference when interpreting claim decisions. This page explains the coverage requirements plan types and covered procedures as well as how to appeal a denial from Anthem. This medical policy is archived effective September 1 2018.

Archived medical policy effective October 7 2020. Anthem Blue Cross Medical Policies and Clinical UM Guidelines update Page 2 of 2 The following AIM Specialty Health Clinical Appropriateness Guidelines have been revised and will be effective on February 22 2021. Our policies are used as guidelines for coverage determinations by all of our health care plans unless otherwise indicated.

This is the medical billing code for gastric bypass surgery. GENE00008 - Analysis of Fecal DNA for Colorectal Cancer Screening and Surveillance. Obstructive Sleep Apnea Treatment.

So be sure to speak to your employer or the HR department to see what coverage you may have. On January 24 2019 the Medical Policy and Technology Assessment Committee MPTAC approved the following Medical Policies applicable to Anthem. Initial and reoperative bariatric procedures are considered not medically necessary when the criteria listed above are not met.

Anthem BCBS Weight Loss Surgery Full Coverage Statement. Medical policies are scientific documents that define the technologies procedures and treatments that are considered medically necessary not medically necessary and investigational link to investigational policy. Medical technology is constantly evolving and these medical policies are.

In addition to the active and pending Medical Policies BCBSIL has included policies which are under development or being revised. This new medical policy will be implemented on January 1 2019. What are the Anthem BC Georgia Criteria for Coverage.

Providers should be knowledgeable about BCBSIL Medical Policies. There are several factors that impact whether a service or procedure is covered under a members beneﬁt plan. The following policies are new and may result in services previously covered now being considered either not medically necessary andor investigational.

Not Medically Necessary. This is usually due to cost considerations. Medical policies and clinical utilization management UM guidelines are two resources that help us determine if a procedure is medically necessary.

Your employer may have an Anthem Blue Cross policy but they may specifically elect to exclude bariatric surgery as a covered service. For additional information refer to the Medical Policy titled. Medical policies are medical determinations about a particular technology service or drug that while such technology service or drug may be medically necessary it is excluded under the terms of a members benefit plan.

The best option is to call them directly and ask if your policy includes coverage for CPT Code 43775. O Interventional Pain Management See August 16 2020 version. Highmarks medical policy guidelines address both clinical and claim payment reimbursement issues.

Bariatric surgical procedures including but not limited to laparoscopic adjustable gastric banding are considered not medically necessary for individuals with a BMI below 35 kgm². To view AIM guidelines visit the AIM Specialty Health page. Anthem covers 5 weight loss procedures including the Gastric Sleeve Gastric Bypass Lap-Band and Duodenal Switch assuming your policy includes bariatric surgery.

Medical policy is NOT intended to replace independent medical judgment for treatment of individuals. Medical Policies On August 22 2019 the Medical Policy and Technology Assessment Committee MPTAC approved the following Medical Policies applicable to Anthem Blue Cross.

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