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.
MA11.106b, Treatment of Gender Dysphoria
Notification: 11/01/2016 | Effective: 01/01/2017 | Posted: 11/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.027c, Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)
Notification: 11/23/2016 | Effective: 12/23/2016 | Posted: 11/23/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.028c, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Notification: 11/30/2016 | Effective: 01/06/2017 | Posted: 11/30/2016


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.
MA05.016a, Home Prothrombin Time Monitoring
Notification: 10/05/2016 | Effective: 11/04/2016 | Posted: 11/04/2016
Type of policy change: Medical Coding

MA08.066a, Ado-Trastuzumab Emtansine (Kadcyla®)
Notification: 10/07/2015 | Effective: 11/06/2015 | Posted: 11/10/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.063a, Pertuzumab (Perjeta®)
Notification: 10/07/2015 | Effective: 11/06/2015 | Posted: 11/10/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.018a, Trastuzumab (Herceptin®)
Notification: 10/07/2015 | Effective: 11/06/2015 | Posted: 11/10/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.042b, Ustekinumab (Stelara™) for Subcutaneous Injection
Effective: 11/16/2016 | Posted: 11/16/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.010b, Ankle-Foot/Knee-Ankle-Foot Orthoses
Notification: 10/20/2016 | Effective: 11/18/2016 | Posted: 11/18/2016
Type of policy change: General Description, Guidelines, or Informational Update

MA11.023d, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Notification: 10/28/2016 | Effective: 11/28/2016 | Posted: 11/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.062a, Repair and Replacement of Durable Medical Equipment (DME)
Effective: 11/30/2016 | Posted: 11/30/2016

MA05.044c, Durable Medical Equipment (DME)
Effective: 11/30/2016 | Posted: 11/30/2016
Type of policy change: Medical Coding

MA08.047b, Pemetrexed (Alimta®)
Effective: 11/30/2016 | Posted: 11/30/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

MA08.012a, Off-label Coverage for Prescription Drugs and/or Biologics
Effective: 11/30/2016 | Posted: 11/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA08.017a, Botulinum Toxin Agents
Reissue Effective: 11/10/2016 | Reissue Posted: 11/10/2016

MA08.050, Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™)
Reissue Effective: 11/10/2016 | Reissue Posted: 11/10/2016

MA08.072a, Bevacizumab (Avastin®)
Reissue Effective: 11/10/2016 | Reissue Posted: 11/10/2016

MA08.019, Infliximab (Remicade®)
Reissue Effective: 11/10/2016 | Reissue Posted: 11/10/2016

MA08.046, Ecallantide (Kalbitor®)
Reissue Effective: 11/10/2016 | Reissue Posted: 11/10/2016

MA11.081, Meniscal Allograft Transplantation
Reissue Effective: 11/09/2016 | Reissue Posted: 11/21/2016

MA07.042, Complete Decongestive Therapy (CDT)
Reissue Effective: 11/09/2016 | Reissue Posted: 11/21/2016

MA11.082a, Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions
Reissue Effective: 11/09/2016 | Reissue Posted: 11/21/2016

MA11.084a, Osteochondral Autograft Transplantation Procedure
Reissue Effective: 11/09/2016 | Reissue Posted: 11/21/2016

MA11.086a, Osteochondral Allograft Transplantation
Reissue Effective: 11/09/2016 | Reissue Posted: 11/21/2016

MA05.058a, Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA06.020a, Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA09.002d, High-Technology Radiology Services
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA09.014a, Computer Aided Detection (CAD) System for use with Chest Radiographs
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA11.026a, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA12.007, Air or Sea Ambulance Transport Services
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016

MA09.021a, Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation
Reissue Effective: 11/23/2016 | Reissue Posted: 11/23/2016


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.
MA08.022c, Rituximab (Rituxan®)
Effective: 10/01/2016 | Posted: 11/10/2016

MA00.010j, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 11/15/2016 | Posted: 11/15/2016










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