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.
00.10.40c, Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
Notification: 03/01/2019 | Effective: 06/01/2019 | Posted: 03/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

08.00.70e, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.72h, Alglucosidase alfa (e.g., Lumizyme®)
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.51j, Enzyme Replacement for the Treatment of Gaucher's Disease
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.39c, Cerliponase alfa (Brineura®)
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria

08.01.26a, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., pegademase bovine [Adagen®], elapegademase-lvlr [Revcovi™])
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.69b, Agalsidase beta (Fabrazyme®)
Notification: 03/05/2019 | Effective: 06/03/2019 | Posted: 03/05/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.50s, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Notification: 03/19/2019 | Effective: 06/17/2019 | Posted: 03/19/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; 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.
09.00.49k, Proton Beam Radiation Therapy
Notification: 11/30/2018 | Effective: 03/01/2019 | Posted: 03/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

09.00.56h, Radiation Therapy Services (Independence)
Notification: 11/30/2018 | Effective: 03/01/2019 | Posted: 03/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

11.00.06j, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring
Effective: 03/04/2019 | Posted: 03/04/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.00.02i, Intravenous Chelation Therapy
Effective: 03/04/2019 | Posted: 03/04/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.14e, Radium Ra 223 dichloride (Xofigo®) Injection (Independence Administrators)
Effective: 03/04/2019 | Posted: 03/04/2019
Type of policy change: Medical Necessity Criteria

08.00.08j, Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)
Effective: 03/04/2019 | Posted: 03/04/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.00.21i, Allergy Immunotherapy
Effective: 03/11/2019 | Posted: 03/11/2019
Type of policy change: General Description, Guidelines, or Informational Update

08.00.98e, Eribulin Mesylate (Halaven®)
Notification: 12/26/2018 | Effective: 03/25/2019 | Posted: 03/25/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

06.02.26d, In Vitro Allergy Testing
Notification: 02/22/2019 | Effective: 03/25/2019 | Posted: 03/25/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.00.03j, Fetal Surgery
Reissue Effective: 02/27/2019 | Reissue Posted: 03/01/2019

09.00.36k, First-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers
Reissue Effective: 02/27/2019 | Reissue Posted: 03/01/2019

05.00.08e, Continuous Passive Motion (CPM) Devices in the Home Setting
Reissue Effective: 02/27/2019 | Reissue Posted: 03/01/2019

08.01.41c, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Reissue Effective: N/A | Reissue Posted: 03/11/2019

08.01.15d, Golimumab (Simponi Aria®) Intravenous (IV) Injection
Reissue Effective: 03/14/2019 | Reissue Posted: 03/14/2019

08.00.62i, Abatacept (Orencia®) for Injection for Intravenous Use
Reissue Effective: 03/14/2019 | Reissue Posted: 03/14/2019

05.00.69b, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Reissue Effective: 03/13/2019 | Reissue Posted: 03/14/2019

08.01.19e, Siltuximab (Sylvant®)
Reissue Effective: 03/14/2019 | Reissue Posted: 03/14/2019

05.00.75, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Reissue Effective: 03/13/2019 | Reissue Posted: 03/14/2019

08.01.48a, Tildrakizumab-asmn (Ilumya™)
Reissue Effective: 03/14/2019 | Reissue Posted: 03/14/2019

07.00.14f, Low-level Laser Therapy (LLLT)
Reissue Effective: 03/13/2019 | Reissue Posted: 03/14/2019

05.00.32i, Speech and Non-Speech Generating Devices
Reissue Effective: 03/13/2019 | Reissue Posted: 03/14/2019

05.00.01l, Pneumatic Compression Therapy Devices
Reissue Effective: 03/13/2019 | Reissue Posted: 03/14/2019

11.15.22d, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 03/28/2019 | Reissue Posted: 03/28/2019

08.00.99b, Belimumab (Benlysta®) for Intravenous Use
Reissue Effective: 03/27/2019 | Reissue Posted: 03/28/2019

05.00.70b, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Reissue Effective: 03/27/2019 | Reissue Posted: 03/28/2019

08.01.03c, Belatacept (Nulojix®)
Reissue Effective: 03/27/2019 | Reissue Posted: 03/28/2019

08.01.24, Deoxycholic Acid (Kybella™)
Reissue Effective: 03/28/2019 | Reissue Posted: 03/28/2019


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