CommercialCoverageMedium impact
[Ohio] Medical Policy and Clinical Guideline updates
Anthem BCBS·OH · Ophthalmology, General Surgery·Medical Policy
Effective date
Jan 1, 2027
We identified it
Jul 31, 2026
Summary
Anthem Blue Cross and Blue Shield Ohio 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. Services previously covered under these categories may now be designated as not medically necessary and therefore denied unless they meet the new criteria.
Action Required
By December 31, 2026: Billing and clinical teams must review the full text of guidelines CG-MED-102 and CG-SURG-116 at https://anthem.com/provider (select Ohio, then Medical Policies & Clinical UM Guidelines). For any patients with amblyopia or hyperhidrosis who may be scheduled for treatment in 2027, verify that proposed procedures will meet the new medical necessity criteria. Update prior authorization request templates and clinical documentation requirements to align with the new guidelines. Educate providers in ophthalmology and general/thoracic surgery on the new requirements. Claims submitted after January 1, 2027 that do not meet the new criteria will be denied. Prior authorizations obtained before the effective date under old guidelines may not be honored after January 1, 2027.