Anthem_Medicare_Part_B_Preferred_Device_Update
Notifies that, effective for dates of service on and after 2020-01-17, specified Medicare Part B injectable/visco-supplement devices will be included in Anthem's preferred device precertification review process; describes criteria for approval of nonpreferred Part B devices and references the Clinical UM Guideline.
Supartz FX, Durolane, Euflexxa, and Gelsyn-3 included in preferred device precertification review process for Medicare Part B devices.
Reference to nonpreferred Part B device list code ING-CC-0005.
Summary of change
Notifies that, effective for dates of service on and after January 17, 2020, specified Medicare Part B injectable/viscosupplement devices will be included in Anthem's preferred device precertification review process. This change is a material modification to prior precertification handling and adds preferred device review in addition to the current medical necessity review.
Describes criteria for approval of nonpreferred Part B devices: approval may be granted when a member is actively receiving listed agents, has had a trial and inadequate response or intolerance to one preferred agent, or preferred agents are unacceptable due to contraindications including hypersensitivity/allergy. References the Clinical Utilization Management (UM) Guideline as the source for medical necessity review.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.