MP/CG Update/Notice - September 2024 Form
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Commercial services provided by Anthem Blue Cross, trade name of Blue Cross of California. Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. CABC-CM-067388-24 September 2024
September 1, 2024
Dear Provider:
Anthem Blue Cross is pleased to provide you with the following updates. Please refer to the specific policy for coding, language, rationale updates and changes that are not summarized below.
NEW Medical Policy with prior authorization required effective December 1, 2024
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CG-MED-97 Biofeedback and Neurofeedback: This document addresses biofeedback, a treatment method
where an individual is given information, via an electronic monitor, about physiological processes that are
normally involuntary, such as blood pressure, muscle tension, heart rate, and other bodily functions, and
neurofeedback (also known as EEG biofeedback), a type of biofeedback that uses electroencephalograms
(EEGs) as the feedback source.
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Outlines the Medically Necessary and Not Medically Necessary criteria for biofeedback and
neurofeedback
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Prior authorization required effective December 1, 2024
New MCG guideline with prior authorization required effective December 1, 2024
Effective December 1, 2024, prior authorization review will be required for inpatient video electroencephalograms (EEGs) for adults using MCG guidelines ORG: M-580 (ISC) and M-580-RRG (ISC) EEG, Video Monitoring. The codes that will require review are 95711, 95712, 95713, 95714, 95715, 95716, 95718, 95720, 95722, 95724 and 95726.
American Society of Addiction Medicine (ASAM) update
While we had previously notified you of a move to The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related and Co-Occurring Conditions, American Society of Addiction Medicine, 4th Edition for adults, such transition to the use of the 4th Edition for medical necessity reviews has been postponed to a future date of October 1, 2024. We will continue to use the 3rd Edition until such time.
For questions, please contact the provider service number on the back of the member's ID card.
We thank you for your continued efforts on behalf of our members and your partnership toward improved access to quality health care for Californians.
Sincerely,
Jo Ann Nishimoto, MD Medical Director Anthem
Walk through this policy with us
Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.