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.
MA07.058f, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA00.047a, Musculoskeletal Services
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: This is a new policy.

MA08.026e, Treatments for Complex Regional Pain Syndrome (CRPS)
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA11.026c, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Notification: 12/01/2017 (revised 02/27/2018) | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA11.102e, Denervation of the Spinal Nerves for Chronic Pain
Notification: 12/01/2017 (revised 02/27/2018) | Effective: 03/01/2018 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA11.033b, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Notification: 12/01/2017 | Effective: 01/01/2018 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.036b, Alglucosidase alfa (e.g., Lumizyme®)
Notification: 12/22/2017 | Effective: 01/22/2018 | Posted: 12/22/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.007b, Nebulizers and Inhalation Solutions
Notification: 12/27/2017 | Effective: 01/26/2018 | Posted: 12/27/2017
Type of policy change: Medical Coding

MA05.010d, Ankle-Foot/Knee-Ankle-Foot Orthoses
Notification: 12/27/2017 | Effective: 01/26/2018 | Posted: 12/27/2017
Type of policy change: Medical Coding

MA11.018b, Mohs' Micrographic Surgery (MMS)
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.044e, Durable Medical Equipment (DME)
Notification: 12/27/2017 | Effective: 01/26/2018 | Posted: 12/27/2017
Type of policy change: Medical Coding

MA07.038c, Neuropsychological Testing for Neurologically Based Conditions
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.001f, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; 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.
MA08.091, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Notification: 10/03/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: This is a new policy.

MA08.090, Lanreotide (Somatuline® Depot)
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
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.
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: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.012b, Cast and Splint Applications and Associated Supplies Provided in the Office Setting
Notification: 09/01/2017 | Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

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: 12/01/2017

MA11.029c, Spinal Discectomy
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

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

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: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA11.015e, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

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: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA07.035b, Transcranial Magnetic Stimulation (TMS) for Medical Conditions
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.030b, Reconstructive Breast Surgery
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA11.096b, Percutaneous Discectomy
Effective: 12/01/2017 | Posted: 12/01/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.025c, Omalizumab (Xolair®)
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.047c, Pemetrexed (Alimta®)
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

MA05.008a, Negative Pressure Wound Therapy (NPWT) Systems
Effective: 12/13/2017 | Posted: 12/13/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

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

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: 12/15/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

MA08.062c, Carfilzomib (Kyprolis™)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

MA08.075b, Ramucirumab (Cyramza®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

MA08.058b, Blinatumomab (Blincyto®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.055d, Histone Deacetylase Inhibitors for Peripheral T-cell Lymphoma (e.g., Istodax®, Beleodaq®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

MA08.049c, Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound)/(Abraxane® for Injectable Suspension)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria

MA05.005c, Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Coding

MA05.026a, Manual Wheelchairs
Effective: 12/27/2017 | Posted: 12/27/2017

MA00.037d, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position

MA08.019c, Infliximab and Related Biosimilars
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.044c, Eculizumab (Soliris®)
Effective: 12/27/2017 | Posted: 12/27/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA09.002f, High-Technology Radiology Services
Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

MA00.005l, Experimental/Investigational Services
Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Coding

MA00.003h, Preventive Care Services
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

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

MA11.033b, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Notification: 12/01/2017 | Effective: 01/01/2018 | Posted: 12/29/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA05.043a, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Reissue Effective: 12/06/2017 | Reissue Posted: 12/06/2017

MA05.032, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Reissue Effective: 12/20/2017 | Reissue Posted: 12/20/2017

MA09.014a, Computer Aided Detection (CAD) System for use with Chest Radiographs
Reissue Effective: 12/20/2017 | Reissue Posted: 12/20/2017


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.
MA00.002f, Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.016c, Home Prothrombin Time Monitoring
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.009e, Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 01/01/2018 | Posted: 12/29/2017

MA07.051d, Intraoperative Neurophysiological Testing
Effective: 01/01/2018 | Posted: 12/29/2017

MA00.006c, Care Management and Care Planning Services
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.004i, Coagulation Factors
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.052a, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.046c, Wheelchair Options and Accessories
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.010h, Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda®, Opdivo®) and Programmed Death-Ligand 1 (PD-L1) Antagonists (e.g., Tecentriq®, Bavencio®, Imfinzi™)
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.057b, Upper Limb Prostheses
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.026d, Complex Regional Pain Syndrome (CRPS) Parenteral Treatments
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.024b, Lower Limb Prostheses
Effective: 01/01/2018 | Posted: 12/29/2017

MA07.056b, Photodynamic Therapy (PDT) Using Levulan® Kerastick® (Aminolevulinic Acid HCl [ALA]) or Metvixia® (Methyl Aminolevulinate [MAL])
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.042g, Ustekinumab (Stelara®)
Effective: 01/01/2018 | Posted: 12/29/2017

MA07.025d, Intrauterine Systems (IUSs) (e.g., Mirena®, Skyla®, Liletta®, Kyleena®)
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.023a, Wheelchair Cushions and Seating
Effective: 01/01/2018 | Posted: 12/29/2017

MA05.063c, Repair or Replacement of an External Prosthetic Device
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.023f, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.039c, Cochlear Implantation
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.088b, Ocrelizumab (Ocrevus™)
Effective: 01/01/2018 | Posted: 12/29/2017

MA06.017k, Molecular Diagnostics
Effective: 01/01/2018 | Posted: 12/29/2017

MA10.007a, Speech Therapy
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.093a, Chimeric Antigen Receptor (CAR) Therapy
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.100c, Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
Effective: 01/01/2018 | Posted: 12/29/2017

MA06.002a, In Vitro Allergy Testing
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.086b, Nusinersen (Spinraza™)
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.078b, Scar Revision
Effective: 01/01/2018 | Posted: 12/29/2017

MA09.020e, Radiation Therapy Services
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.011b, Artificial Hearts and Ventricular Assist Devices (VADs)
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.001e, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.007j, Medicare Part B vs. Part D Crossover Drugs
Effective: 01/01/2018 | Posted: 12/29/2017

MA06.006c, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Treatment
Effective: 01/01/2018 | Posted: 12/29/2017

MA08.089a, Cerliponase alfa (Brineura™)
Effective: 01/01/2018 | Posted: 12/29/2017

MA10.003d, Physical Medicine & Rehabilitation Services: Physical Therapy (PT) and Occupational Therapy (OT)
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.049c, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Effective: 01/01/2018 | Posted: 12/29/2017

MA07.008a, Platelet-Rich Plasma (PRPs) for Chronic Non-Healing Wounds and Stem-Cell Therapy for Orthopedic Applications
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.019c, Vagus Nerve Stimulation (VNS)
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.012b, Endovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Effective: 01/01/2018 | Posted: 12/29/2017

MA11.015f, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Effective: 01/01/2018 | Posted: 12/29/2017


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA08.039a, Plerixafor Injection (Mozobil®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

MA08.046, Ecallantide (Kalbitor®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

MA08.060b, Pegloticase (Krystexxa®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017

MA08.038c, Oxaliplatin (Eloxatin®)
Notification: 12/01/2017 | Archive Effective: 01/01/2018 | Posted: 12/01/2017










Connect with Us        


© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.