Active Policy Notifications
Select Cardiology Guidelines
Lab Management Guidelines
News & Announcements
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.
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
Policy Effective Date
Notification Issue Date
Trigger Point Injections
Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
Agalsidase beta (Fabrazyme®)
Alglucosidase alfa (e.g., Lumizyme®)
Cerliponase alfa (Brineura®)
Enzyme Replacement for the Treatment of Gaucher's Disease
Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., pegademase bovine [Adagen®], elapegademase-lvlr [Revcovi™])
Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)
Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
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®)
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.