Policy Bulletins
The Policy Bulletins listed below represent our catalogue of medical and claim payment policies. If you are looking for a specific type of policy, choose a category from the menu on the right. You may also use the search function in the top menu to search for policies by word or phrase.
 
   

Policy #
Policy Bulletin Title
Show details for
MA00.026g
Always Bundled Procedure Codes
Show details for
MA00.037h
Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
MA00.006f
Care Management and Care Planning Services
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MA00.012b
Cast and Splint Applications and Associated Supplies Provided in the Office Setting
MA00.049
Consultation Services
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MA00.002f
Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
MA00.044b
Criteria for Reimbursement of Emergency Room Services
MA00.032b
Direct Access to Obstetrics/Gynecology (OB/GYN) Services
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MA00.005u
Experimental/Investigational Services
MA00.040a
Facility Reporting of Observation Services
MA00.045d
Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
MA00.023a
Inpatient Hospital Readmission
MA00.022
Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
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MA00.030p
Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
MA00.038a
Marijuana for Medical Use
MA00.011e
Modifier 62: Two Surgeons
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MA00.014d
Modifier 66: Surgical Team
MA00.015d
Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
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MA00.050
Multiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
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MA00.047b
Musculoskeletal Services
MA00.041
National Correct Coding Initiative (NCCI) Code Pair Edits
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MA00.039c
Never Events and Preventable Adverse Events
MA00.001a
Obsolete or Unreliable Diagnostic Tests and Medical Services
Show details for
MA00.010z
PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Show details for
MA00.003m
Preventive Care Services
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MA00.019f
Radiologic Guidance of a Procedure
MA00.009g
Reporting and Documentation Requirements for Anesthesia Services
MA00.024b
Reporting Requirements for Drugs and Biologics
MA00.004a
Routine Costs of Clinical Trials and Coverage of Investigational Devices A and B
Show details for
MA00.033g
Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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MA00.021a
STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point-of-Service (POS) Products
MA00.036g
Telehealth Services
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MA00.031d
X-rays Associated with Fractures in the Office Setting









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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.