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.
11.00.14f, Treatment of Twin-Twin Transfusion Syndrome (TTTS)
Notification: 05/14/2019 | Effective: 08/12/2019 | Posted: 05/14/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

06.02.36c, Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators)
Notification: 05/17/2019 | Effective: 06/17/2019 | Posted: 05/17/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.44i, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Notification: 05/17/2019 | Effective: 06/17/2019 | Posted: 05/17/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.39c, Measurement of Serum Antibodies to and Measurement of Serum Levels Using Anser™ or DoseAssure™ Tests
Notification: 05/31/2019 | Effective: 07/01/2019 | Posted: 05/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.57, Lutathera® (Lutetium Lu 177 Dotatate) (Independence Administrators)
Notification: 05/31/2019 | Effective: 07/01/2019 | Posted: 05/31/2019
Type of policy change: This is a new policy.

06.02.52m, eviCore Lab Management Program (Independence)
Notification: 05/31/2019 | Effective: 07/01/2019 | Posted: 05/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.49l, Proton Beam Radiation Therapy
Notification: 05/31/2019 | Effective: 07/01/2019 | Posted: 05/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding


New Policies
The following commercial policies have been newly developed to communicate coverage and/or reimbursement positions, reporting requirements, and other processes and procedures for doing business with Independence Blue Cross
06.02.54, Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Notification: 04/29/2019 | Effective: 05/28/2019 | Posted: 05/28/2019
Type of policy change: This is a new policy.


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.
11.02.27a, Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)
Notification: 04/01/2019 | Effective: 05/01/2019 | Posted: 05/01/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

00.01.24h, Obsolete or Unreliable Diagnostic Tests and Medical Services
Effective: 05/06/2019 | Posted: 05/06/2019
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.25k, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Notification: 04/08/2019 | Effective: 05/06/2019 | Posted: 05/06/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.06.04k, Uterine Artery Embolization
Effective: 05/20/2019 | Posted: 05/20/2019
Type of policy change: General Description, Guidelines, or Informational Update

11.06.05f, Endometrial Ablation
Effective: 05/20/2019 | Posted: 05/20/2019
Type of policy change: General Description, Guidelines, or Informational Update

11.07.02j, Sentinel Lymph Node Biopsy and Mapping
Effective: 05/31/2019 | Posted: 05/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

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: 05/31/2019
Type of policy change: General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
06.02.55, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

07.02.09e, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.47b, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators)
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.31f, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.09g, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (Independence Administrators)
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.49b, VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.38d, Nerve Fiber Density Testing
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.04d, Fetal Fibronectin Enzyme (fFN) Immunoassay
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.45, Vectra® DA Blood Test for Rheumatoid Arthritis
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

06.02.50, GPS Cancer™ Testing by NantHealth
Reissue Effective: 05/08/2019 | Reissue Posted: 05/08/2019

11.06.07d, Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

09.00.02e, Electron Beam Computed Tomography (EBCT) for Screening Evaluations
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

09.00.40d, Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

06.02.56a, Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

09.00.24c, Full-Body Computerized Tomography (CT) Scan Screening
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

09.00.42c, Computer-Aided Detection (CAD) System for Use with Chest Radiographs
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

07.03.15d, Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)
Reissue Effective: 05/09/2019 | Reissue Posted: 05/09/2019

11.05.07d, Surgical Correction of Strabismus
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

05.00.14j, High-Frequency Chest Wall Oscillation Devices
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

05.00.38j, Negative-Pressure Wound Therapy (NPWT) Systems
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

11.01.07d, Cataract Surgery
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

12.01.03, Cosmetic Procedures
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

11.05.11c, Implantation of Intrastromal Corneal Ring Segments (ICRS)
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

11.03.01e, Repair of Cleft Lip, Cleft Nose, and/or Cleft Palate
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

08.00.55h, Omalizumab (Xolair®)
Reissue Effective: 05/22/2019 | Reissue Posted: 05/23/2019

08.01.38b, Ocrelizumab (Ocrevus™)
Reissue Effective: 05/23/2019 | Reissue Posted: 05/23/2019

08.01.21c, Blinatumomab (Blincyto®)
Reissue Effective: 05/23/2019 | Reissue Posted: 05/23/2019

08.01.12b, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 05/23/2019 | Reissue Posted: 05/23/2019


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
06.00.01e, Computer Analysis and Generation of Automated Data in Conjunction with Diagnostic Studies
Notification: 05/03/2019 | Archive Effective: 06/03/2019 | Posted: 05/03/2019


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