Clinical Utilization Management Guidelines (DME-related)
List and adoption notice of the health plan's Clinical Utilization Management (UM) Guidelines, including numerous Durable Medical Equipment (DME) guideline titles; governs medical necessity review and utilization management for Anthem members in the listed jurisdiction(s).
No material clinical or coverage changes in this revision.
Coverage Criteria Overview
This section provides an index-style listing of the Clinical Utilization Management Guidelines adopted by the plan. It does not contain detailed medical necessity rules, exclusions, or coverage criteria within these entries. For each guideline title listed, refer to the specific Clinical UM Guideline document (e.g., CG-DME-## or CG-SURG-##) for the complete medical necessity criteria and coverage determination logic.
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