Site Activity
This page provides a monthly listing of publication activity on the Medical Policy Portal including Policy Notifications, New Policies, Updated Policies, Coding Updates, Reissued Policies, and Archived Policies. To view publication activity from prior months, select Past Site Activity.

Past Site Activity

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Notifications
The following Independence Blue Cross commercial policies have been posted prior to their effective date.
07.03.05w, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (Independence)
Notification: 11/11/2019 | Effective: 02/09/2020 | Posted: 11/11/2019
Type of policy change: Medical Necessity Criteria

09.00.46y, High-Technology Radiology Services (Independence)
Notification: 11/11/2019 | Effective: 02/09/2020 | Posted: 11/11/2019
Type of policy change: Medical Necessity Criteria

11.15.03k, Implantable Infusion Pumps
Notification: 11/19/2019 | Effective: 02/17/2020 | Posted: 11/19/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Updated Policies
The following commercial policies have been reviewed and updated to communicate current coverage and/or reimbursement positions, reporting requirements, and other procedures for doing business with Independence Blue Cross.
05.00.04e, Coverage of Medical Devices
Effective: 11/04/2019 | Posted: 11/04/2019
Type of policy change: General Description, Guidelines, or Informational Update

11.00.18a, Use of a Robotic-Assisted Surgical System
Effective: 11/04/2019 | Posted: 11/04/2019
Type of policy change: General Description, Guidelines, or Informational Update

08.01.37a, Drugs Used for the Maintenance Treatment of Opioid or Alcohol Use Disorder (e.g., Naltrexone Implants, Probuphine Implant, Sublocade Injection, Vivitrol Injection)
Effective: 11/04/2019 | Posted: 11/04/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.26i, Home Prothrombin Time Monitoring
Effective: 11/04/2019 | Posted: 11/04/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

09.00.46x, High-Technology Radiology Services (Independence)
Notification: 08/16/2019 | Effective: 11/10/2019 | Posted: 11/11/2019
Type of policy change: Medical Necessity Criteria

09.00.11d, Contrast Agents Used in Conjunction with Echocardiography
Effective: 11/18/2019 | Posted: 11/18/2019
Type of policy change: Medical Coding

09.00.45h, Magnetic Resonance Imaging (MRI) Contrast Agents
Effective: 11/18/2019 | Posted: 11/18/2019
Type of policy change: Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
06.02.37a, Immune Cell Function Assay
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

07.00.10i, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

11.04.01c, Islet Cell Transplantation
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

06.02.43b, Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

05.00.60h, Pressure-Reducing Support Surfaces
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

09.00.17o, Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

02.01.01d, Home Health Care Services
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

11.05.01f, Refractive Keratoplasty
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

08.01.42a, Edaravone (Radicava™)
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

11.08.13g, Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

07.11.02f, Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

06.02.06p, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

07.05.08a, Fecal Microbiota Transplantation (FMT)
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

11.03.15h, Gastric Electrical Stimulation (Enterra™), Gastric Pacing
Reissue Effective: 11/06/2019 | Reissue Posted: 11/08/2019

06.02.35v, Genetic Testing (Independence Administrators)
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

07.13.06k, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Reissue Effective: 11/08/2019 | Reissue Posted: 11/08/2019

00.01.45, Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

00.01.47c, Inpatient Hospital Readmission
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.03.14n, Intraoperative Neurophysiological Monitoring (INM)
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

12.00.01f, Acupuncture (Independence)
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.03.18o, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.03.10e, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

05.00.77a, Subcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.03.21k, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.03.09p, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

07.13.07j, Corneal Pachymetry Using Ultrasound
Reissue Effective: 11/20/2019 | Reissue Posted: 11/20/2019

11.02.26b, Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Reissue Effective: 11/21/2019 | Reissue Posted: 11/21/2019

07.13.11i, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Reissue Effective: 11/21/2019 | Reissue Posted: 11/21/2019

11.00.13g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Reissue Effective: 11/21/2019 | Reissue Posted: 11/21/2019

07.13.08e, Partial Coherence Interferometry
Reissue Effective: 11/21/2019 | Reissue Posted: 11/21/2019

11.05.08d, Photocoagulation of Macular Drusen
Reissue Effective: 11/21/2019 | Reissue Posted: 11/21/2019


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