Effective December 1, 2017, Anthem Blue Cross will implement a new policy restricting outpatient advanced radiologic imaging procedures in the hospital setting. The updated policy, originally scheduled to become effective October 1 but recently delayed, indicates that advanced radiologic imaging procedures in the hospital outpatient department are only considered medically necessary under the following circumstances:

• If services are only available in the hospital setting; or
• The patient requires obstetrical observation; or
• The patient is receiving perinatology services; or
• There are no other geographically accessible appropriate alternative sites to perform the service, including in instances where:
• General anesthesia or moderate or deep sedation is required and unavailable at a freestanding facility; or
• Patient size prohibits the use of equipment at a freestanding facility; or
• The patient has documented history of claustrophobia.