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Click here to view the United Healthcare (UHC) Medical Policy Updates March 2025 United Anthem BCBS Medical Policy Updates January 2025 Click here to view the Anthem BCBS Blue Cross Blue Shield Medical Policy Updates January 2025 Anthem BCBS Medical Policy Updates: Ablative Techniques as a Treatment for Barretts Esophagus Absolute Quantitation of Myocardial Blood Flow Measurement Activity Therapy for Autism Spectrum Disorders and Rett Syndrome Acupuncture Adipose-derived Regenerative Cell Therapy and Soft Tissue Augmentation Procedures Advanced Lipoprotein Testing Air Conduction Hearing Aids Alcohol Septal Ablation for Treatment of Hypertrophic Cardiomyopathy Allergy Immunotherapy (Subcutaneous) Allogeneic Xenographic Synthetic Bioengineered and Composite Products for Wound Healing and Soft Tissue Grafting Altered Auditory Feedback Devices for Fluency Disorders Ambulance Services Air and Water Ambulance Services Ground Emergent Ambulance Services Ground Non-Emergent Ambulatory or Outpatient Surgery Center Procedures Anesthesia Services and Moderate (Conscious) Sedation Anesthesia Services for Interventional Pain Management Procedures Ankle-Foot & Knee-Ankle-Foot Orthoses Annulus Closure After Discectomy Artificial Anal Sphincter for the Treatment of Severe Fecal Incontinence Artificial Intelligence-Based Software for Prostate Cancer Detection Artificial Retinal Devices Assistant Surgeons Auditory Brainstem Responses (ABRs) and Evoked Otoacoustic Emissions (OAEs) for Hearing Disorders Autologous and Allogeneic Pancreatic Islet Cell Transplantation Automated External Defibrillators for Home Use Automated Insulin Delivery Systems Automated Nerve Conduction Testing Autonomic Testing Axial Lumbar Interbody Fusion Back-Up Ventilators in the Home Setting Balloon Dilation of the Eustachian Tubes Bariatric Surgery and Other Treatments for Clinically Severe Obesity Biofeedback and Neurofeedback Biomagnetic Therapy Biomechanical Footwear Therapy Blepharoplasty Blepharoptosis Repair and Brow Lift Bone Mineral Density Testing Measurement Bone-Anchored and Bone Conduction Hearing Aids Brain Computer Interface Rehabilitation Devices Breast Ductal Examination and Fluid Cytology Analysis Breast Procedures including Reconstructive Surgery Implants and Other Breast Procedures Bronchial Thermoplasty Cancer Antigen 125 Testing Cancer Antigen 19-9 Testing Carcinoembryonic Antigen Testing Cardiac Contractility Modulation Therapy Cardiac Electrophysiological Studies (EPS) and Catheter Ablation Cardiac Stress Testing with Electrocardiogram Carotid Sinus Baroreceptor Stimulation Devices Carotid Vertebral and Intracranial Artery Stent Placement with or without Angioplasty Carpal Tunnel Decompression Surgery Cataract Removal Surgery for Adults Catheter-based Embolization Procedures for Malignant Lesions Outside the Liver Cell Transplantation (Mesencephalic Adrenal-Brain and Fetal Xenograft) Cellular Therapy Products for Allogeneic Stem Cell Transplantation Cervical and Thoracic Discography Cervical Cancer Screening Using Cytology and Human Papillomavirus Testing Cervical Traction Devices for Home Use Chelation Therapy Chronic Wound Care in the Home or Outpatient Setting Clinical Utilization Management (UM) Guideline for Pre-Payment Review Medical Necessity Determinations When No Other Clinical UM Guideline Exists Coblation Therapies for Musculoskeletal Conditions Cochlear Implants and Auditory Brainstem Implants Colonoscopy Compression Devices for Lymphedema Continuous Glucose Monitoring Devices and External Insulin Infusion Pumps Continuous Local Delivery of Analgesia to Operative Sites using an Elastomeric Infusion Pump during the Post-Operative Period Continuous Monitoring of Intraocular Pressure Continuous Passive Motion Devices in the Home Setting Convection Enhanced Delivery of Therapeutic Agents to the Brain Cooling Devices and Combined Cooling Heating Devices Corneal Collagen Cross-Linking Cosmetic and Reconstructive Services of the Head and Neck Cosmetic and Reconstructive Services of the Trunk and Groin Cosmetic and Reconstructive Services Skin Related Cranial Remodeling Bands and Helmets (Cranial Orthotics) Cryoablation for Plantar Fasciitis and Plantar Fibroma Cryoneurolysis Cryopreservation of Oocytes or Ovarian Tissue Cryosurgical Radiofrequency or Laser Ablation to Treat Solid Tumors Outside the Liver Custodial Care Custom-made Knee Braces Deep Brain Cortical and Cerebellar Stimulation Destruction of Pre-Malignant Skin Lesions Detection of Circulating Tumor Cells Diagnostic Fiberoptic Flexible Laryngoscopy Diagnostic Infertility Surgery Diaphragmatic Phrenic Nerve Stimulation and Diaphragm Pacing Systems Digital Therapy Devices for Treatment of Amblyopia Donor Lymphocyte Infusion for Hematologic Malignancies after Allogeneic Hematopoietic Progenitor Cell Transplantation Doppler-Guided Transanal Hemorrhoidal Dearterialization Drug Testing or Screening in the Context of Substance Use Disorder and Chronic Pain Drug-Eluting Devices for Maintaining Sinus Ostial Patency Durable Medical Equipment Dynamic Low-Load Prolonged-Duration Stretch Devices Dynamic Spinal Visualization (Including Digital Motion X-ray and Cineradiography Videofluoroscopy) Electric Breast Pumps Electric Tumor Treatment Field (TTF) Electrical Impedance Scanning for Cancer Detection Electrical Nerve Stimulation Transcutaneous Percutaneous Electrical Stimulation as a Treatment for Pain and Other Conditions Surface and Percutaneous Devices Electroencephalography and Video Electroencephalographic Monitoring Electromyography and Nerve Conduction Studies Electronic Home Visual Field Monitoring Electrophysiology-Guided Noninvasive Stereotactic Cardiac Radioablation Electrothermal Shrinkage of Joint Capsules Ligaments and Tendons Endometrial Ablation Endothelial Keratoplasty Enhanced External Counterpulsation in the Outpatient Setting Epiduroscopy External Ambulatory Cardiac Monitors External Infusion Pumps for the Administration of Drugs in the Home or Residential Care Settings External Insulin Pumps External Upper Limb Stimulation for the Treatment of Tremors Extracorporeal Carbon Dioxide Removal Extracorporeal Shock Wave Therapy Extraosseous Subtalar Joint Implantation and Subtalar Arthroereisis Eye Movement Analysis Using Non-spatial Calibration for the Diagnosis of Concussion Facet Joint Allograft Implants for Facet Disease Fecal Analysis in the Diagnosis of Intestinal Disorders Fetal Surgery for Prenatally Diagnosed Malformations Focal Laser Ablation for the Treatment of Prostate Cancer Foot Care Services Functional Electrical Stimulation (FES) Threshold Electrical Stimulation (TES) Functional Endoscopic Sinus Surgery (FESS) Fundus Photography Gamma Glutamyl Transferase Testing Gastric Electrical Stimulation Gene Therapy for Aromatic L-Amino Acid Decarboxylase Deficiency Gene Therapy for Beta Thalassemia Gene Therapy for Cerebral Adrenoleukodystrophy Gene Therapy for Duchenne Muscular Dystrophy Gene Therapy for Hemophilia Gene Therapy for Metachromatic Leukodystrophy Gene Therapy for Ocular Conditions Gene Therapy for Sickle Cell Disease Gene Therapy for Spinal Muscular Atrophy Genicular Nerve Blocks and Ablation for Chronic Knee Pain Heart Lung Transplantation Heart Transplantation Hematopoietic Stem Cell Transplantation for Autoimmune Disease and Miscellaneous Solid Tumors Hematopoietic Stem Cell Transplantation for Diabetes Mellitus Hematopoietic Stem Cell Transplantation for Genetic Diseases and Aplastic Anemias Hematopoietic Stem Cell Transplantation for Germ Cell Tumors Hematopoietic Stem Cell Transplantation for Hodgkin Disease and non-Hodgkin Lymphoma Hematopoietic Stem Cell Transplantation for Multiple Myeloma and Other Plasma Cell Dyscrasias Hematopoietic Stem Cell Transplantation for Pediatric Solid Tumors Hematopoietic Stem Cell Transplantation for Select Leukemias and Myelodysplastic Syndrome Hepzato Kit (melphalan hepatic delivery system) High Frequency Chest Compression Devices for Airway Clearance High-volume Colonic Irrigation Home Enteral Nutrition Home Health Home Oxygen Therapy Home Parenteral Nutrition Home Phototherapy Devices for Neonatal Hyperbilirubinemia Hospital Beds and Accessories Human Chorionic Gonadotropin Testing Hyperbaric Oxygen Therapy (Systemic Topical) Hyperoxemic Reperfusion Therapy Idiopathic Environmental Illness (IEI) Immune Cell Function Assay Immunizations Implantable Ambulatory Event Monitors and Mobile Cardiac Telemetry Implantable Infusion Pumps Implantable Left Atrial Hemodynamic Monitor Implantable Middle Ear Hearing Aids Implantable Peripheral Nerve Stimulation Devices as a Treatment for Pain Implantable Shock Absorber for Treatment of Knee Osteoarthritis Implantation of Occipital Supraorbital or Trigeminal Nerve Stimulation Devices (and Related Procedures) Implanted Artificial Iris Devices Implanted Devices for Spinal Stenosis Implanted Port Delivery Systems to Treat Ocular Disease In Vitro Chemosensitivity Assays and In Vitro Chemoresistance Assays Infant Home Apnea Monitors Ingestible Devices for the Treatment of Constipation Ingestion Event Monitors Inhaled Nitric Oxide Injection Treatment for Mortons Neuroma Inpatient Interfacility Transfers Intensive In-home Behavioral Health Services Intensive Programs for Pediatric Feeding Disorders Internal Rib Fixation Systems Interspinous Process Fixation Devices Intervertebral Stabilization Devices Intracardiac Ischemia Monitoring Intracytoplasmic Sperm Injection (ICSI) Intraocular Anterior Segment Aqueous Drainage Devices (without extraocular reservoir) Intraocular Telescope Intraoperative Assessment of Surgical Margins During Breast-Conserving Surgery with Radiofrequency Spectroscopy or Optical Coherence Tomography Intraoperative Neurophysiological Monitoring Intrapulmonary Percussive Ventilation Devices Intravascular Brachytherapy (Coronary and Non-Coronary) Investigational Criteria Iontophoresis Keratoprosthesis Ketogenic Diet for Treatment of Intractable Seizures Laboratory Evaluation of Vitamin B12 Laser Trabeculoplasty and Laser Peripheral Iridotomy Laser Treatment for Onychomycosis Lifting Devices for Use in the Home Lingual Frenotomy for Ankyloglossia-Related Feeding Difficulties Liver Transplantation Locoregional and Surgical Techniques for Treating Primary and Metastatic Liver Malignancies Lower Esophageal Sphincter Augmentation Devices for the Treatment of Gastroesophageal Reflux Disease (GERD) Lower Limb Prosthesis Low-Frequency Ultrasound Therapy for Wound Management Lumbar Discography Lung and Lobar Transplantation Lysis of Epidural Adhesions Machine Learning Derived Probability Score for Rapid Kidney Function Decline Magnetic Resonance Neurography Magnetization-Prepared Rapid Acquisition Gradient Echo Magnetic Resonance Imaging (MPRAGE MRI) Mandibular Maxillary (Orthognathic) Surgery Manipulation Under Anesthesia Mastectomy for Gynecomastia Maze Procedure Mechanical Circulatory Assist Devices (Ventricular Assist Devices Percutaneous Ventricular Assist Devices and Artificial Hearts) Mechanical Embolectomy for Treatment of Stroke Mechanical Insufflation-Exsufflation Devices Mechanized Spinal Distraction Therapy Medical Necessity Criteria Medical Policy Formation Metagenomic Sequencing for Infectious Disease in the Outpatient Setting Microprocessor Controlled Knee-Ankle-Foot Orthosis Microprocessor Controlled Lower Limb Prosthesis Microsurgical Procedures for the Prevention or Treatment of Lymphedema Minimally Invasive Ablative Procedures for Epilepsy Minimally Invasive Treatment of the Posterior Nasal Nerve to Treat Rhinitis Mobile Device-Based Health Management Applications Moderate to Deep Anesthesia Services for Dental Surgery in the Facility Setting Mohs Micrographic Surgery Molecular Gastrointestinal Pathogen Panel (GIPP) Testing for Infectious Diarrhea in the Outpatient Setting Molecular Signature Test for Predicting Response to Tumor Necrosis Factor Inhibitor Therapy Monitored Anesthesia Care for Gastrointestinal Endoscopic Procedures MRI Guided High Intensity Focused Ultrasound Ablation for Non-Oncologic Indications Multi-biomarker Disease Activity Blood Tests for Rheumatoid Arthritis Multiplex Autoantigen Microarray Testing for Systemic Lupus Erythematosus Myocardial Strain Imaging Myocardial Sympathetic Innervation Imaging with or without Single-Photon Emission Computed Tomography (SPECT) Myoelectric Upper Extremity Prosthetic Devices Myringotomy and Tympanostomy Tube Insertion Nanoparticle-Mediated Thermal Ablation Nasal Surgery for the Treatment of Obstructive Sleep Apnea and Snoring Nasal Valve Repair Navigational Bronchoscopy Near-Infrared Coronary Imaging and Near-Infrared Intravascular Ultrasound Coronary Imaging Near-Infrared Spectroscopy Scanning for Brain Hematoma Screening Neonatal Levels of Care Nerve Graft after Prostatectomy Neuromuscular Electrical Training for the Treatment of Obstructive Sleep Apnea or Snoring Neuromuscular Stimulation in the Treatment of Muscle Atrophy Neutron Beam Radiotherapy Noninvasive Electrical Bone Growth Stimulation of the Appendicular Skeleton Non-invasive Heart Failure and Arrhythmia Management and Monitoring System Noninvasive Home Ventilator Therapy for Respiratory Failure Non-invasive Measurement of Advanced Glycation End Products (AGEs) in the Skin Non-Invasive Measurement of Left Ventricular End Diastolic Pressure in the Outpatient Setting Non-Obstetric Gynecologic Duplex Ultrasonography of the Abdomen and Pelvis in the Outpatient Setting Non-Obstetrical Transvaginal Ultrasonography Nucleic Acid Amplification Tests Using Algorithmic Analysis for the Diagnosis of Bacterial Vaginosis Occipital Nerve Block Therapy for the Treatment of Headache and Occipital Neuralgia Open Sacroiliac Joint Fusion Ophthalmic use of NdYAG Laser for Posterior Capsulotomy Optical Detection for Screening and Identification of Cervical Cancer Orthopedic Footwear Osseointegrated Limb Prostheses Outpatient Alpha-Fetoprotein Testing Outpatient Cardiac Hemodynamic Monitoring Using a Wireless Sensor for Heart Failure Management Outpatient Cardiac Rehabilitation Outpatient Cystourethroscopy Outpatient Glycated Hemoglobin and Protein Testing Outpatient Laboratory-based Blood Glucose Testing Outpatient Urine Culture Pain Management Biomarker Analysis Pancreas Transplantation and Pancreas Kidney Transplantation Panniculectomy and Abdominoplasty Paraesophageal Hernia Repair Partial Left Ventriculectomy Patent Foramen Ovale and Left Atrial Appendage Closure Devices for Stroke Prevention Pediatric Gait Trainers Penile Circumcision Penile Prosthesis Implantation Per- and Polyfluoroalkyl Substances (PFAS) Testing Percutaneous and Endoscopic Spinal Surgery Percutaneous Ultrasonic Ablation of Soft Tissue Percutaneous Vertebral Disc and Vertebral Endplate Procedures Peripheral Nerve Blocks for Treatment of Neuropathic Pain Physiologic Recording of Tremor using Accelerometer(s) and Gyroscope(s) Pneumatic Compression Devices for Prevention of Deep Vein Thrombosis of the Extremities in the Home Setting Pooled Antibiotic Sensitivity Testing Portable Normothermic Organ Perfusion Systems Posterior Segment Optical Coherence Tomography Powered Robotic Lower Body Exoskeleton Devices Powered Wheeled Mobility Devices Prefabricated and Prophylactic Knee Braces Prefabricated External Infant Ear Molding Systems Preoperative Testing for Low Risk Invasive Procedures and Surgeries Pressure Reducing Support Surfaces Groups 1 2 & 3 Private Duty Nursing in the Home Setting Proprietary Algorithms for Liver Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease Prostate Saturation Biopsy Prostate Specific Antigen Testing Protein Biomarkers for the Screening Detection and Management of Prostate Cancer Prothrombin Time Self-Monitoring Devices Pulmonary Rehabilitation Quantitative Muscle Testing Devices Quantitative Sensory Testing Quantitative Ultrasound for Tissue Characterization Radioactive Seed Localization of Nonpalpable Breast Lesions Radiofrequency Ablation of the Renal Sympathetic Nerves Radiostereometric Analysis (RSA) Red Blood Cell Folic Acid Testing Reduction Mammaplasty Refractive Surgery Rehabilitative and Habilitative Services in the Home Setting Physical Medicine Physical Therapy Occupational Therapy and Speech-Language Pathology Rehabilitative Devices with Remote Monitoring Remote Devices for Intermittent Monitoring of Intraocular Pressure Remote Therapeutic and Physiologic Monitoring Services Respiratory Viral Panel Testing in the Outpatient Setting Resting Electrocardiogram Screening in Adults Review of Services for Benefit Determinations in the Absence of a Company Applicable Medical Policy or Clinical Utilization Management (UM) Guideline Rhinophototherapy Robotic Arm Assistive Devices Rupture of Membranes Testing in Pregnancy Sacral Nerve Stimulation and Percutaneous Tibial Nerve Stimulation for Urinary and Fecal Incontinence Urinary Retention Sacral Nerve Stimulation as a Treatment of Neurogenic Bladder Secondary to Spinal Cord Injury Scoliosis Surgery Screening for Vitamin D Deficiency in Average Risk Individuals Seat Lift Mechanisms Selected Blood Serum and Cellular Allergy and Toxicity Tests Selected Protein Biomarker Algorithmic Assays Selected Sleep Testing Services Self-Expanding Absorptive Sinus Ostial Dilation Self-Operated Spinal Unloading Devices Sensory Stimulation for Brain-Injured Individuals in Coma or Vegetative State Septoplasty Serologic Testing for Biomarkers of Irritable Bowel Syndrome (IBS) Serological Antibody Testing For Helicobacter Pylori Serum Amylase Testing Serum Biomarker Tests for Multiple Sclerosis Serum Biomarker Tests for Risk of Preeclampsia Silver-based Products for Wound and Soft Tissue Applications Site of Care Specialty Pharmaceuticals Skilled Nursing and Skilled Rehabilitation Services (Outpatient) Skin Nerve Fiber Density Testing Small Bowel Small Bowel Liver and Multivisceral Transplantation Spectral Analysis of Prostate Tissue by Fluorescence Spectroscopy Spinal Orthoses Thoracic-Lumbar-Sacral (TLSO) Lumbar-Sacral (LSO) and Lumbar Standing Frames Static Progressive Stretch (SPS) and Patient-Actuated Serial Stretch (PASS) Devices Strapping Surface Electromyography and Electrodermal Activity Sensor Devices for Seizure Monitoring Surgical and Ablative Treatments for Chronic Headaches Surgical Strabismus Correction Surgical Treatment for Dupuytrens Contracture Surgical Treatment of Hyperhidrosis Systems Pathology Testing for Prostate Cancer Technologies for the Evaluation of Skin Lesions (including Dermatoscopy Epiluminescence Microscopy Videomicroscopy and Ultrasonography) Temporomandibular Disorders Testing for Biochemical Markers for Alzheimers Disease Testing for Oral and Esophageal Cancer Therapeutic Apheresis Therapeutic Shoes Inserts or Modifications for Individuals with Diabetes Therapeutic use of Stem Cells Blood and Bone Marrow Products Three-Dimensional (3-D) Rendering of Imaging Studies Thymus Tissue Transplantation Thyroid Testing Tonsillectomy for Children with or without Adenoidectomy Tonsillectomy with or without Adenoidectomy for Adults Transanal Endoscopic Microsurgical (TEM) Excision of Rectal Lesions Transanal Irrigation Transanal Radiofrequency Treatment of Fecal Incontinence Transcatheter Ablation of Arrhythmogenic Foci in the Pulmonary Veins Transcatheter Heart Valve Procedures Transcatheter Uterine Artery Embolization Transendoscopic Therapy for Gastroesophageal Reflux Disease Dysphagia and Gastroparesis Transmyocardial Perventricular Device Closure of Ventricular Septal Defects Transmyocardial Revascularization Transrectal Ultrasonography Treatment of Keloids and Scar Revision Treatment of Varicose Veins (Lower Extremities) Treatments for Urinary Incontinence Trigger Point Injections Tropism Testing for HIV Management Ultrafiltration in Decompensated Heart Failure Ultrasonic Diathermy Devices Ultrasound Ablation for Oncologic Indications Ultrasound Bone Growth Stimulation Ultraviolet Light Therapy Delivery Devices for Home Use Umbilical Cord Blood Progenitor Cell Collection Storage and Transplantation Upper Extremity Myoelectric Orthoses Upper Gastrointestinal Endoscopy in Adults Use of 3-D 4-D or 5-D Ultrasound in Maternity Care Uterine Fibroid Ablation Laparoscopic Percutaneous or Transcervical Image Guided Techniques Uterine Transplantation Vacuum Assisted Wound Therapy in the Outpatient Setting Vagus Nerve Stimulation Vein Embolization as a Treatment for Pelvic Congestion Syndrome and Varicocele Vestibular Function Testing Virtual Reality-Assisted Therapy Systems Wearable Cardioverter Defibrillators Wearable Devices for Stress Relief and Management Wheeled Mobility Devices Manual Wheelchairs Standard Heavy Duty and Lightweight Wheeled Mobility Devices Manual Wheelchairs-Ultra Lightweight Wheeled Mobility Devices Wheelchair Accessories Wireless Capsule for the Evaluation of Suspected Gastric and Intestinal Motility Disorders Wireless Cardiac Resynchronization Therapy for Left Ventricular Pacing Zika Virus Testing How Does Policy Alerts Work

demonstrated that high IFNGR1 expression significantly enhances anti-PD-L1 efficacy [96], suggesting that targeting IFNGR1 palmitoylation to modulate its expression may represent a promising strategy to enhance immunotherapy outcomes in OSCC