Active Notifications
The notifications listed below represent new policy versions that are scheduled to become active on the intended Policy Effective Date. These notifications allow you to become familiar with the new policy version in advance of its release. Please check back frequently as notifications are posted often.

Note: The documents below are strictly notifications of future policy updates. The positions and criteria addressed in the notification are not enforced until the Policy Effective Date. To view current company policies, go to the Policy Bulletins section of this site or click here.



Policy Effective Date
Notification Title
Notification Issue Date
Hide details for 06/17/201906/17/2019
Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators)
05/17/2019
Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
05/17/2019
Hide details for
Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
03/19/2019
Attachment A (Dosing and Frequency Requirements For Rituximab (Rituxan®) infusion and related biosimilars, and rituximab/hyaluronidase human for subcutaneous injection (Rituxan Hycela®)) to 08.00.50s Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Attachment B (ICD-10 CODES AND NARRATIVES) to 08.00.50s Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Hide details for 06/29/201906/29/2019
Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (Independence)
04/30/2019
Hide details for 07/01/201907/01/2019
Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
04/02/2019
Hide details for
eviCore Lab Management Program (Independence)
05/31/2019
Attachment A (Procedure Codes Requiring Pre-service and Prepayment Reviews) to 06.02.52m eviCore Lab Management Program (Independence)
Attachment B (Procedure Codes Requiring Prepayment Reviews) to 06.02.52m eviCore Lab Management Program (Independence)
Hide details for
High-Technology Radiology Services (Independence)
04/01/2019
Attachment A (High-Technology Radiology Services Code List ) to 09.00.46w High-Technology Radiology Services (Independence)
Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators)
05/31/2019
Measurement of Serum Antibodies to and Measurement of Serum Levels Using Anser™ or DoseAssure™ Tests
05/31/2019
Hide details for
Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)
04/01/2019
Attachment A (Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound Code List) to 11.02.27b Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)
Hide details for
Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
04/02/2019
Attachment A (ICD-10 Diagnosis Code Number(s) and Narrative(s)) to 07.07.03m Photodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])
Hide details for
Proton Beam Radiation Therapy
05/31/2019
Attachment A (ICD-10 Diagnosis Codes) to 09.00.49l Proton Beam Radiation Therapy
Hide details for
Radiation Therapy Services (Independence)
04/01/2019
Attachment A (CPT, HCPCS and Revenue Codes) to 09.00.56i Radiation Therapy Services (Independence)
Hide details for 07/29/201907/29/2019
Hide details for
Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
04/30/2019
Attachment A (Skin substitutes and their approved indications.) to 11.08.20t Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Hide details for 08/12/201908/12/2019
Treatment of Twin-Twin Transfusion Syndrome (TTTS)
05/14/2019

Connect with Us        


© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.