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.
MA00.045b, Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs)
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.031d, X-rays Associated with Fractures in the Office Setting
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.033e, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.007e, Obstetrical Ultrasounds for members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017

MA11.105d, Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Notification: 11/01/2017 | Effective: 01/30/2018 | Posted: 11/01/2017

MA00.030k, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.010q, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 11/01/2017 | Effective: 12/01/2017 | Posted: 11/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA11.028d, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Notification: 11/15/2017 | Effective: 12/15/2017 | Posted: 11/15/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

MA07.031, Laboratory-Based Vestibular Function Testing
Notification: 11/15/2017 | Effective: 02/13/2018 | Posted: 11/15/2017
Type of policy change: This is a new policy.

MA05.063b, Repair or Replacement of an External Prosthetic Device
Notification: 11/15/2017 | Effective: 12/15/2017 | Posted: 11/15/2017
Type of policy change: Medical Coding

MA07.009e, Routine Foot Care for Certain Medical Conditions
Notification: 11/17/2017 | Effective: 02/15/2018 | Posted: 11/17/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.015c, Home Blood Glucose Monitors and Supplies
Notification: 11/29/2017 | Effective: 12/29/2017 | Posted: 11/29/2017
Type of policy change: Medical Necessity Criteria


New Policies
The following Medicare Advantage 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.
MA05.067, Leadless Pacemakers
Notification: 10/04/2017 | Effective: 11/03/2017 | Posted: 11/03/2017
Type of policy change: This is a new policy.

MA08.092, Edaravone (Radicava™)
Notification: 10/18/2017 | Effective: 11/17/2017 | Posted: 11/17/2017
Type of policy change: This is a new policy.

MA08.093, Chimeric Antigen Receptor (CAR) Therapy
Effective: 11/29/2017 | Posted: 11/29/2017
Type of policy change: This is a new policy.


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.
MA08.042f, Ustekinumab (Stelara®)
Effective: 11/01/2017 | Posted: 11/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.068c, Brentuximab Vedotin (Adcetris®)
Effective: 11/01/2017 | Posted: 11/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

MA08.063b, Pertuzumab (Perjeta®)
Effective: 11/01/2017 | Posted: 11/01/2017
Type of policy change: Medical Necessity Criteria

MA05.062c, Repair and Replacement of Durable Medical Equipment (DME)
Effective: 11/01/2017 | Posted: 11/01/2017
Type of policy change: Medical Coding

MA00.002e, Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
Notification: 10/04/2017 | Effective: 11/03/2017 | Posted: 11/03/2017

MA00.005k, Experimental/Investigational Services
Effective: 11/03/2017 | Posted: 11/03/2017
Type of policy change: Medical Coding

MA11.106c, Treatment of Gender Dysphoria
Effective: 11/03/2017 | Posted: 11/03/2017
Type of policy change: Medical Necessity Criteria

MA07.058e, Sleep Disorder Testing and Positive Airway Pressure Therapy
Effective: 11/10/2017 | Posted: 11/10/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

MA08.045d, Tocilizumab (Actemra®) for Intravenous Infusion
Effective: 11/15/2017 | Posted: 11/15/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.007i, Medicare Part B vs. Part D Crossover Drugs
Notification: 10/18/2017 | Effective: 11/17/2017 | Posted: 11/17/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

MA11.031e, Spinal Cord and Dorsal Root Ganglion Stimulation
Notification: 08/23/2017 | Effective: 11/21/2017 | Posted: 11/21/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA05.045a, Compression Garments
Reissue Effective: 11/08/2017 | Reissue Posted: 11/09/2017

MA09.011a, Electron Beam Computed Tomography (EBCT) for Screening Evaluations
Reissue Effective: 11/08/2017 | Reissue Posted: 11/09/2017

MA07.026, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Reissue Effective: 11/08/2017 | Reissue Posted: 11/09/2017

MA05.058a, Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue Effective: 11/22/2017 | Reissue Posted: 11/22/2017

MA05.001a, High-Frequency Chest Wall Oscillation Devices
Reissue Effective: 11/22/2017 | Reissue Posted: 11/22/2017

MA06.004, In Vivo Allergy Sensitivity Testing
Notification: 10/01/2014 | Reissue Effective: 11/27/2017 | Reissue Posted: 11/27/2017

MA11.013a, Percutaneous Left Atrial Appendage (LAA) Closure for Non-Valvular Atrial Fibrillation (NVAF)
Reissue Effective: 11/27/2017 | Reissue Posted: 11/27/2017

MA06.002, In Vitro Allergy Testing
Reissue Effective: 11/27/2017 | Reissue Posted: 11/27/2017

MA09.021b, Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation
Reissue Effective: 11/28/2017 | Reissue Posted: 11/28/2017

MA11.056d, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA08.029a, Natalizumab (Tysabri®)
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA11.023e, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA08.082, Pegfilgrastim (Neulasta®)
Notification: 09/30/2016 | Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA08.052c, Denosumab (Prolia®, Xgeva®)
Notification: 12/15/2016 | Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA06.019a, Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA08.003c, Enteral Nutritional Therapy
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA06.017j, Molecular Diagnostics
Reissue Effective: 11/29/2017 | Reissue Posted: 11/29/2017

MA06.015c, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

MA06.022c, Biomarkers for Oncology
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

MA06.010a, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

MA12.002, Nonemergency Ambulance Transport
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

MA11.004e, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

MA06.008b, Pharmacogenetic Testing to Determine Drug Sensitivity
Reissue Effective: 11/30/2017 | Reissue Posted: 11/30/2017

(Not Categorized)
MA11.040b, Transcatheter Closure of Cardiac Septal Defects
Effective: 11/17/2017 | Posted: 11/17/2017










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