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.
MA07.004a, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Notification: 12/01/2016 | Effective: 01/01/2017 | Posted: 12/01/2016
Type of policy change: Medical Coding

MA08.080, Daptomycin (Cubicin®)
Notification: 12/01/2016 | Effective: 01/01/2017 | Posted: 12/01/2016
Type of policy change: This is a new policy.

MA08.085, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Notification: 12/02/2016 | Effective: 01/01/2017 | Posted: 12/02/2016
Type of policy change: This is a new policy.

MA08.083, Gonadotropin-Releasing Hormone Agonist (Eligard®, Lupron Depot®)
Notification: 12/14/2016 | Effective: 03/14/2017 | Posted: 12/14/2016
Type of policy change: This is a new policy.

MA08.052c, Denosumab (Prolia®, Xgeva®)
Notification: 12/15/2016 | Effective: 03/14/2017 | Posted: 12/15/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA00.023a, Inpatient Hospital Readmission
Notification: 12/15/2016 | Effective: 01/15/2017 | Posted: 12/15/2016
Type of policy change: General Description, Guidelines, or Informational Update

MA08.073c, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (e.g., ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®])
Notification: 12/28/2016; revised 02/16/2017 | Effective: 03/28/2017 | Posted: 12/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update


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.
MA08.080, Daptomycin (Cubicin®)
Notification: 12/01/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: This is a new policy.

MA08.082, Pegfilgrastim (Neulasta®)
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: This is a new policy.

MA08.085, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Notification: 12/02/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: This is a new policy.

MA08.081, Fulvestrant (Faslodex®)
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
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.
MA00.009d, Reporting and Documentation Requirements for Anesthesia Services
Notification: 09/02/2016 | Effective: 12/01/2016 | Posted: 12/01/2016

MA07.001a, Hyperbaric Oxygen Therapy
Notification: 09/02/2016 | Effective: 12/01/2016 | Posted: 12/01/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA11.074a, Excision of Redundant Skin
Effective: 12/05/2016 | Posted: 12/05/2016
Type of policy change: Medical Coding

MA07.002b, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Effective: 12/14/2016 | Posted: 12/14/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA07.022b, Wireless Capsule Endoscopy
Effective: 12/16/2016 | Posted: 12/16/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

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

MA07.023b, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Effective: 12/28/2016 | Posted: 12/28/2016

MA08.070a, Golimumab (Simponi® Aria™) Intravenous (IV) Injection
Effective: 12/28/2016 | Posted: 12/28/2016

MA08.028b, Abatacept (Orencia®) for Injection for Intravenous Use
Effective: 12/28/2016 | Posted: 12/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.045c, Tocilizumab (Actemra®) for Intravenous Infusion
Effective: 12/28/2016 | Posted: 12/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.009c, Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 12/28/2016 | Posted: 12/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.038c, Oxaliplatin (Eloxatin®)
Effective: 12/28/2016 | Posted: 12/28/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.091a, Manipulation Under Anesthesia
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.106b, Treatment of Gender Dysphoria
Notification: 11/01/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA09.020c, Radiation Therapy Services (Independence)
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding

MA00.036b, Remote Patient Management: Telemedicine Services
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA11.008a, Refractive Keratoplasty
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.007f, Medicare Part B vs. Part D Crossover Drugs
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA00.005h, Experimental/Investigational Services
Notification: 09/30/2016 | Effective: 01/01/2017 | Posted: 12/30/2016

MA08.077b, Talimogene laherparepvec (Imlygic™)
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

MA07.017b, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Notification: 10/01/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding

MA09.009f, Diagnostic and Therapeutic Radiopharmaceutical Agents
Notification: 10/03/2016 | Effective: 01/01/2017 | Posted: 12/30/2016

MA07.004a, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Notification: 12/01/2016 | Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding

MA07.046d, Corneal Pachymetry Using Ultrasound
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding

MA11.055c, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

MA00.003f, Preventive Care Services
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

MA00.006b, Care Management and Care Planning Services
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Coverage and/or Reimbursement Position

MA11.048b, Lumbar Interspinous Process Decompression System
Effective: 01/01/2017 | Posted: 12/30/2016
Type of policy change: Medical Coding


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA08.056a, Eribulin Mesylate (Halaven™)
Reissue Effective: 12/05/2016 | Reissue Posted: 12/05/2016

MA08.031a, Cetuximab (Erbitux®)
Reissue Effective: 12/05/2016 | Reissue Posted: 12/05/2016

MA08.053a, Personalized Vaccines (e.g., Provenge®)
Reissue Effective: 12/05/2016 | Reissue Posted: 12/05/2016

MA08.011b, Erythropoiesis Stimulating Agents (ESAs)
Reissue Effective: 12/05/2016 | Reissue Posted: 12/05/2016

MA08.048a, Ofatumumab (Arzerra™)
Reissue Effective: 12/05/2016 | Reissue Posted: 12/05/2016

MA11.012a, Endovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Reissue Effective: 12/06/2016 | Reissue Posted: 12/06/2016

MA11.073, Abdominoplasty and/or Panniculectomy
Reissue Effective: 12/06/2016 | Reissue Posted: 12/06/2016

MA11.047a, Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
Reissue Effective: 12/06/2016 | Reissue Posted: 12/06/2016

MA11.075, Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty
Reissue Effective: 12/09/2016 | Reissue Posted: 12/09/2016

MA11.071a , Selective Photothermolysis Using Pulsed-Dye Lasers (PDL)
Reissue Effective: 12/09/2016 | Reissue Posted: 12/09/2016

MA11.070, Lipectomy and Liposuction
Reissue Effective: 12/09/2016 | Reissue Posted: 12/09/2016

MA05.006a, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Reissue Effective: 12/09/2016 | Reissue Posted: 12/09/2016

MA11.015c, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Reissue Effective: 12/12/2016 | Reissue Posted: 12/12/2016

MA11.030a, Reconstructive Breast Surgery
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA11.078a, Scar Revision
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA01.003, Organ and Tissue Recovery from a Cadaveric Donor and Associated Services
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA11.051a, Treatment of Obesity and Bariatric Surgery for Treatment of Morbid Obesity
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA11.072, Application and Removal of Tattoos
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA11.033a, Solid Organ Transplants
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA05.021, Injectable Dermal Fillers
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA12.002, Nonemergency Ambulance Transport
Reissue Effective: 12/14/2016 | Reissue Posted: 12/14/2016

MA11.018a, Mohs' Micrographic Surgery (MMS)
Reissue Effective: 12/21/2016 | Reissue Posted: 12/21/2016

MA11.050, Treatment of Medical and Surgical Complications
Reissue Effective: 12/21/2016 | Reissue Posted: 12/21/2016

MA06.001b, Apheresis Therapy
Reissue Effective: 12/21/2016 | Reissue Posted: 12/21/2016

MA06.002, In Vitro Allergy Testing
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA06.004, In Vivo Allergy Sensitivity Testing
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA11.108, Spinal Fusion
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA05.018a, Osteogenic Stimulators (i.e., Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System)
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA07.044a, Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA11.085a, Arthroscopic Electrothermal Joint Repair
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA08.058a, Blinatumomab (Blincyto™)
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA10.004c, Chiropractic Services
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA11.099, Septoplasty, Rhinoplasty, and Septorhinoplasty
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA07.008, Platelet-Rich Plasma (PRPs) for Chronic Non-Healing Wounds and Stem-Cell Therapy for Orthopedic Applications
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA07.024a, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA11.025, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 12/21/2016 | Reissue Posted: 12/22/2016

MA08.061, Belatacept (Nulojix®)
Reissue Effective: 12/21/2016 | Reissue Posted: 12/23/2016

MA07.047b, Pain Management of Peripheral Nerves by Injection
Reissue Effective: 12/09/2016 | Reissue Posted: 12/23/2016


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.
MA06.022b, Biomarkers for Oncology
Effective: 10/01/2016 | Posted: 12/14/2016

MA00.010k, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.053d, Implantable and External Infusion Pumps
Effective: 01/01/2017 | Posted: 12/30/2016

MA00.015b, Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.044d, Durable Medical Equipment (DME)
Effective: 01/01/2017 | Posted: 12/30/2016

MA03.011b, Modifiers 26 (Professional Component) and TC (Technical Component)
Effective: 01/01/2017 | Posted: 12/30/2016

MA07.051c, Intraoperative Neurophysiological Testing
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.010c, Ankle-Foot/Knee-Ankle-Foot Orthoses
Effective: 01/01/2017 | Posted: 12/30/2016

MA06.025b, Presumptive and Definitive Drug Testing
Effective: 01/01/2017 | Posted: 12/30/2016

MA00.011c, Modifier 62: Two Surgeons
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.003c, Enteral Nutritional Therapy
Effective: 01/01/2017 | Posted: 12/30/2016

MA00.014b, Modifier 66: Surgical Team
Effective: 01/01/2017 | Posted: 12/30/2016

MA03.002a, Modifier 50: Bilateral Procedure
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.036a, Commodes
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.024c, Interleukin-5 Antagonist for Severe Eosinophilic Asthma (e.g., Nucala®, Cinqair®)
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.013b, Knee Braces
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.039a, Non-Implantable Pelvic Floor Electrical Stimulator
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.019a, Infliximab (Remicade®)
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.011a, Seat Lift Mechanisms
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.030b, Spinal Orthoses
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.004g, Coagulation Factors
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.046b, Wheelchair Options and Accessories
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.026b, Complex Regional Pain Syndrome (CRPS) Parenteral Treatments
Effective: 01/01/2017 | Posted: 12/30/2016

MA06.017f, Molecular Diagnostics
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.062b, Repair and Replacement of Durable Medical Equipment (DME)
Effective: 01/01/2017 | Posted: 12/30/2016

MA05.054c, Urological Supplies
Effective: 01/01/2017 | Posted: 12/30/2016

MA06.001c, Apheresis Therapy
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.042c, Ustekinumab (Stelara™) for Subcutaneous Injection
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.078b, Sebelipase alfa (Kanuma®)
Effective: 01/01/2017 | Posted: 12/30/2016

MA11.023e, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Effective: 01/01/2017 | Posted: 12/30/2016

MA11.015d, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 01/01/2017 | Posted: 12/30/2016

MA11.056c, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Effective: 01/01/2017 | Posted: 12/30/2016

MA08.079b, Daratumumab (Darzalex™)
Effective: 01/01/2017 | Posted: 12/30/2016

MA11.029b, Spinal Discectomy
Effective: 01/01/2017 | Posted: 12/30/2016


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA08.041b, Bendamustine Hydrochloride (Treanda®)
Notification: 12/13/2016 | Archive Effective: 01/14/2017 | Posted: 12/13/2016










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