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.
MA12.003, Acute Care Facility Inpatient Transfers
Notification: 11/02/2018 (Revised 11/12/2018) | Effective: 01/01/2019 | Posted: 11/02/2018
Type of policy change: This is a new policy.

MA09.020h, Radiation Therapy Services
Notification: 11/30/2018 (Revised: 12/18/2018) | Effective: 03/01/2019 | Posted: 11/30/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA00.040a, Facility Reporting of Observation Services
Notification: 11/30/2018 | Effective: 01/01/2019 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position

MA10.008c, Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD)
Notification: 11/30/2018 | Effective: 01/01/2019 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position

MA00.003j, Preventive Care Services
Notification: 11/30/2018 (Revised 12/26/2018) | Effective: 01/01/2019 | Posted: 11/30/2018
Type of policy change: Medical Necessity Criteria; Medical Coding


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.
MA08.100, Patisiran (Onpattro™)
Effective: 11/19/2018 | Posted: 11/19/2018
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.
MA08.079d, Daratumumab (Darzalex™)
Effective: 11/05/2018 | Posted: 11/05/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.090a, Lanreotide (Somatuline® Depot)
Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.085a, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: Medical Necessity Criteria

MA05.025b, Pressure-Reducing Support Surfaces
Effective: 11/26/2018 | Posted: 11/26/2018
Type of policy change: Medical Coding

MA00.026d, Always Bundled Procedure Codes
Effective: 11/26/2018 | Posted: 11/26/2018
Type of policy change: Medical Coding


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA08.021a, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

MA11.101, Nucleoplasty
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

MA08.053a, Personalized Vaccines (e.g., Provenge®)
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

MA11.072, Application and Removal of Tattoos
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

MA00.013, Physician/Nonphysician Standby Services
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

MA07.039a, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

MA00.017, Medical Team Conferences
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

MA09.004a, Echocardiography Contrast Agents
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

MA03.005a, Modifiers XE, XS, XP, XU, 59
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA03.018, Modifier 53: Discontinued Procedure
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA06.008b, Pharmacogenetic Testing to Determine Drug Sensitivity
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA03.017a, Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA06.010a, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA08.067a, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA11.030b, Reconstructive Breast Surgery
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA08.042g, Ustekinumab (Stelara®)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA11.025, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA11.095a, Lysis of Epidural Adhesions
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

MA11.106c, Treatment of Gender Dysphoria
Reissue Effective: 11/21/2018 | Reissue Posted: 11/27/2018

MA08.008c, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Nutrition (IPN)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/27/2018

MA07.038d, Neuropsychological Testing for Neurologically Based Conditions
Reissue Effective: 11/21/2018 | Reissue Posted: 11/27/2018

MA08.092, Edaravone (Radicava™)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/27/2018

MA07.018a, Anorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
Reissue Effective: 11/21/2018 | Reissue Posted: 11/27/2018

MA06.012c, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

MA06.022d, Biomarkers for Oncology
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

MA06.019a, Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

MA07.055a, Allergy Immunotherapy
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

MA06.025g, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

MA08.025c, Omalizumab (Xolair®)
Reissue Effective: 11/28/2018 | Reissue Posted: 11/28/2018

MA06.031c, Vitamin D Assay Testing
Reissue Effective: 11/28/2018 | Reissue Posted: 11/28/2018

MA06.017n, Molecular Diagnostics
Reissue Effective: 11/28/2018 | Reissue Posted: 11/28/2018


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.
MA06.031c, Vitamin D Assay Testing
Effective: 10/01/2018 | Posted: 11/09/2018

MA06.022d, Biomarkers for Oncology
Effective: 10/01/2018 | Posted: 11/09/2018

MA06.025g, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 10/01/2018 | Posted: 11/09/2018

MA06.017n, Molecular Diagnostics
Effective: 10/01/2018 | Posted: 11/09/2018


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA00.007e, Obstetrical Ultrasounds for members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Notification: 11/30/2018 | Archive Effective: 01/01/2019 | Posted: 11/30/2018

MA00.027f, Diagnostic Radiology Services Included in Capitation
Notification: 11/30/2018 | Archive Effective: 01/01/2019 | Posted: 11/30/2018

MA00.028b, Outpatient Short-Term Rehabilitation Services Included in Capitation
Notification: 11/30/2018 | Archive Effective: 01/01/2019 | Posted: 11/30/2018

MA00.029e, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 11/30/2018 | Archive Effective: 01/01/2019 | Posted: 11/30/2018










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