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
 
                                                                                                        

Notifications
The following Independence Blue Cross Medicare Advantage policies have been posted prior to their effective date.
MA11.012d, Endovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Notification: 10/01/2019 | Effective: 12/30/2019 | Posted: 10/01/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA08.073f, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.023i, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

MA08.016e, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 10/03/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.060d, Pegloticase (Krystexxa®)
Notification: 10/15/2019 | Effective: 01/13/2020 | Posted: 10/15/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA09.020j, Radiation Therapy Services
Notification: 10/21/2019 (Revised 12/04/2019) | Effective: 01/21/2020 | Posted: 10/21/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA00.005t, Experimental/Investigational Services
Notification: 10/29/2019 (Revised - 01/03/2020) | Effective: 01/27/2020 | Posted: 10/29/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding


Updated Policies
The following Medicare Advantage 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.
MA00.032b, Direct Access to Obstetrics/Gynecology (OB/GYN) Services
Effective: 10/07/2019 | Posted: 10/07/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA00.005s, Experimental/Investigational Services
Effective: 10/01/2019 | Posted: 10/11/2019
Type of policy change: Medical Coding

MA07.005b, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA08.004p, Coagulation Factors
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.029b, Natalizumab (Tysabri®)
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.009h, Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 10/21/2019 | Posted: 10/21/2019
Type of policy change: Medical Necessity Criteria; Medical Coding


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA09.008a, Low Osmolar Contrast Agents
Reissue Effective: 10/09/2019 | Reissue Posted: 10/10/2019

MA09.005a, High Osmolar Contrast Agents
Reissue Effective: 10/09/2019 | Reissue Posted: 10/10/2019

MA06.012c, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA06.008b, Pharmacogenetic Testing to Determine Drug Sensitivity
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA00.038a, Marijuana for Medical Use
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA07.020a, Photography, including Documentation and Record-Keeping Photography, Whole Body Integumentary Photography, Dermoscopy, and Dermatoscopy
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA07.053, Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA08.103b, Moxetumomab pasudotox-tdfk (Lumoxiti™)
Reissue Effective: 10/10/2019 | Reissue Posted: 10/10/2019

MA08.021b, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 10/09/2019 | Reissue Posted: 10/11/2019

MA08.003d, Enteral Nutritional Therapy
Reissue Effective: 10/23/2019 | Reissue Posted: 10/23/2019

MA11.099a, Septoplasty, Rhinoplasty, and Septorhinoplasty
Reissue Effective: 10/23/2019 | Reissue Posted: 10/23/2019


Coding Update
The following Medicare Advantage policies have been reviewed and updated to add new and revised medical codes (e.g., ICD-9 and ICD-10 diagnosis codes; CPT® and HCPCS codes; revenue codes) and/or remove terminated medical codes.
MA05.025c, Pressure-Reducing Support Surfaces
Effective: 10/01/2019 | Posted: 10/01/2019

MA05.016e, Home Prothrombin Time Monitoring
Effective: 10/01/2019 | Posted: 10/01/2019

MA05.006d, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.009g, Routine Foot Care for Certain Medical Conditions
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.007f, Pulmonary Function Tests
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.031a, Laboratory-Based Vestibular Function Testing
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.047f, Pain Management of Peripheral Nerves by Injection
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.026d, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.033f, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Effective: 10/01/2019 | Posted: 10/01/2019

MA07.013d, Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
Effective: 10/01/2019 | Posted: 10/01/2019

MA00.003l, Preventive Care Services
Effective: 10/01/2019 | Posted: 10/01/2019

MA08.052g, Denosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity™)
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.018d, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Effective: 10/01/2019 | Posted: 10/02/2019

MA07.050f, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.021b, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.044e, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™)
Effective: 10/01/2019 | Posted: 10/02/2019

MA11.001i, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.072e, Bevacizumab (Avastin®) and Related Biosimilars
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.104b, Emapalumab-lzsg (Gamifant®)
Effective: 10/01/2019 | Posted: 10/02/2019

MA08.100b, Patisiran (Onpattro™)
Effective: 10/01/2019 | Posted: 10/02/2019

MA10.004f, Chiropractic Services
Effective: 10/01/2019 | Posted: 10/02/2019

MA11.013b, Percutaneous Left Atrial Appendage (LAA) Closure for Non-Valvular Atrial Fibrillation (NVAF)
Effective: 10/01/2019 | Posted: 10/03/2019

MA11.015i, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 10/01/2019 | Posted: 10/03/2019

MA11.030d, Reconstructive Breast Surgery
Effective: 10/01/2019 | Posted: 10/03/2019

MA11.014e, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Effective: 10/01/2019 | Posted: 10/03/2019

MA11.060c, Catheter Ablation of Cardiac Arrhythmias
Effective: 10/01/2019 | Posted: 10/03/2019

MA11.107c, Implantable Steroid-Eluting Sinus Stents
Effective: 10/01/2019 | Posted: 10/04/2019

MA11.077d, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 10/01/2019 | Posted: 10/04/2019

MA08.105b, Tagraxofusp-erzs (Elzonris™)
Effective: 10/01/2019 | Posted: 10/04/2019

MA08.103b, Moxetumomab pasudotox-tdfk (Lumoxiti™)
Effective: 10/01/2019 | Posted: 10/04/2019

MA08.102a, Mogamulizumab-kpkc (Poteligeo®)
Effective: 10/01/2019 | Posted: 10/04/2019

MA11.029e, Spinal Discectomy
Effective: 10/01/2019 | Posted: 10/21/2019

MA06.025k, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 10/01/2019 | Posted: 10/21/2019

MA11.044e, Artificial Intervertebral Disc Insertion
Effective: 10/01/2019 | Posted: 10/21/2019

MA06.017q, Molecular Diagnostics
Effective: 10/01/2019 | Posted: 10/21/2019

MA00.010w, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2019 | Posted: 10/22/2019

MA00.030o, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 10/01/2019 | Posted: 10/24/2019


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA04.001, Dental Extractions Prior to Cardiac Surgery, Radiation Therapy, or Transplant Surgery
Notification: 10/14/2019 | Archive Effective: 11/18/2019 | Posted: 10/14/2019

MA00.013, Physician/Nonphysician Standby Services
Notification: 10/25/2019 | Archive Effective: 01/01/2020 | Posted: 10/25/2019










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