CommercialCoverageMedium impact
[Virginia] Medical Policy and Clinical Guideline updates
Anthem BCBS·VA · Ophthalmology, General Surgery·Medical Policy
Effective date
Jan 1, 2027
We identified it
Jul 31, 2026
Summary
Anthem Blue Cross and Blue Shield is implementing two new clinical guidelines effective January 1, 2027: CG-MED-102 for dichoptic digital therapy for amblyopia and CG-SURG-116 for surgical treatment of hyperhidrosis. These guidelines establish medical necessity criteria for these services, and previously covered services may now be designated as not medically necessary and therefore not covered.
Action Required
By December 1, 2026: Billing and clinical teams must review both new clinical guidelines (CG-MED-102 and CG-SURG-116) in detail on the Anthem provider portal at https://anthem.com/provider. Identify any current patients receiving dichoptic digital therapy for amblyopia or undergoing surgical treatment of hyperhidrosis (endoscopic thoracic sympathectomy). Beginning January 1, 2027, all claims for these services must satisfy the new medical necessity criteria outlined in the guidelines or will be denied as not medically necessary. Update billing staff to flag these service types for enhanced review and documentation verification prior to claim submission. Providers should communicate with patients about potential coverage changes before the effective date.