MP/CG Update/Notice - February 2020 Form

Anthem Blue Cross is the 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.

February 1, 2020

[Provider Name]
[Address] [City], [State] [Zip]

Dear Provider:

Anthem Blue Cross (Anthem) is pleased to provide you with updated Medical Policies, Clinical UM Guidelines and Clinical Criteria. Please refer to the specific policy for coding, language, and rationale updates and changes that are not summarized below.

Effective May 17, 2020

The following updates will apply to the AIM Musculoskeletal Program: Joint Surgery and Spine Surgery Clinical Appropriateness Guidelines.

Joint Surgery Updates by section:
Shoulder Arthroplasty  Added steroid injection for all joints exclusion based on panel recommendation  Added exclusions for use of xenografts or biologic scaffold for augmentation or bridging reconstruction, use of platelet rich plasma or other biologics and concomitant subacromial decompression  Removed indication for subacromial impingement with rotator cuff tear
Hip arthroplasty  Added exclusion for steroid injection for joint being replaced within the past 6 weeks  Added labral tear indication Knee Arthroscopy and Open Procedures  Added chondroplasty indication  Narrowed use of lateral release to lateral compression as a cause for anterior knee pain or chondromalacia patella  Added a conservative management and advanced osteoarthritis exclusion to patellar compression syndrome section Code changes  Added CPT codes 27425, 27570

Spine Surgery Updates by section:
No criteria changes Code changes only  Added CPT codes 0200T, 0201T

Anthem Blue Cross is the 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.

Updates to AIM Advanced Imaging Clinical Appropriateness Guidelines  

Effective for dates of service on and after May 17, 2020, the following updates will apply to the AIM Advanced Imaging: Vascular Imaging Clinical Appropriateness Guidelines. Updates by section:   

Aneurysm of the abdominal aorta or iliac arteries  Added new indication for asymptomatic enlargement by imaging  Clarified surveillance intervals for stable aneurysms as follows: o Treated with endografts, annually o Treated with open surgical repair, every 5 years Stenosis or occlusion of the abdominal aorta or branch vessels, not otherwise specified
 Added surveillance indication and interval for surgical bypass grafts

As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
 Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.  Access AIM via the Availity Web Portal at availity.com  Call the AIM Contact Center toll-free number: 1-877-291-0360, Monday – Friday, 7:00 a.m. – 5:00 p.m.

For questions related to guidelines, please contact AIM via email at aim.guidelines@aimspecialtyhealth.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.

The complete list of our Medical Policies and Clinical UM Guidelines may be accessed on the Anthem’s Web site at http://www.anthem.com/ca and then hovering over “Providers”, then selecting “Policies and Guidelines” under the Provider Resources column, scrolling down to select “View Medical Policies & UM Guidelines”, then selecting “Medical Policies and Clinical UM Guidelines (for Local Plan members)”, then selecting “Continue” at the bottom of the page.

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,

John Yao, MD, MPH, MBA, MPP, FACP Chief Medical Officer