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.
MA00.003m, Preventive Care Services
Notification: 12/02/2019 | Effective: 01/01/2020 | Posted: 12/02/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

MA12.007a, Air Ambulance Services
Notification: 12/02/2019 | Effective: 01/01/2020 | Posted: 12/02/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA12.002b, Ground Ambulance Transport Services (Emergency and Nonemergency)
Notification: 12/02/2019 | Effective: 01/01/2020 | Posted: 12/02/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA12.003a, Acute Care Facility Inpatient Transfers
Notification: 12/02/2019 | Effective: 12/30/2019 | Posted: 12/02/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA08.050a, Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™)
Notification: 12/03/2019 (Revised 01/14/2020) | Effective: 03/02/2020 | Posted: 12/03/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

MA10.005b, Day Rehabilitation
Notification: 12/13/2019 | Effective: 01/13/2020 | Posted: 12/13/2019

MA11.032f, Multiple Surgery Payment Reduction
Notification: 12/30/2019 | Effective: 03/30/2020 | Posted: 12/30/2019
Type of policy change: 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.
MA07.032, Tumor Treating Fields
Effective: 09/01/2019 | Posted: 12/16/2019
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.
MA08.083b, Gonadotropin-Releasing Hormone Agonist (Eligard®, Lupron Depot®)
Effective: 12/02/2019 | Posted: 12/02/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA07.040b, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Effective: 12/02/2019 | Posted: 12/02/2019
Type of policy change: Medical Coding

MA08.031d, Cetuximab (Erbitux®)
Effective: 12/02/2019 | Posted: 12/02/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

MA11.004f, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Notification: 09/03/2019 | Effective: 12/02/2019 | Posted: 12/02/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.093e, Chimeric Antigen Receptor (CAR) Therapy
Effective: 01/01/2019 | Posted: 12/09/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA08.079e, Daratumumab (Darzalex™)
Effective: 12/02/2019 | Posted: 12/10/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.017d, Botulinum Toxin Agents
Notification: 09/18/2019 | Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.047d, Pemetrexed (Alimta®)
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Medical Necessity Criteria

MA08.085b, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Medical Necessity Criteria

MA08.024f, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA07.041b, Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA11.097d, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA03.005b, Modifiers XE, XS, XP, XU, and 59
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA00.036e, Telehealth Services
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA01.005d, Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA03.008b, Modifier 78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA03.010d, Modifier 57 Decision for Surgery
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA03.017b, Modifiers for Shared or Split Surgical Services (Modifiers 54, 55, 56)
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA05.007c, Nebulizers and Inhalation Solutions
Effective: 12/16/2019 | Posted: 12/16/2019

MA03.009d, Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA03.012c, Modifier 79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA00.014d, Modifier 66: Surgical Team
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Coverage and/or Reimbursement Position

ma03.001a, Modifier 76: Repeat Procedure or Service by Same Physican or Qualified Health Professional
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA03.007a, Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional
Effective: 12/16/2019 | Posted: 12/16/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA08.007p, Medicare Part B vs. Part D Crossover Drugs
Effective: 12/02/2019 | Posted: 12/23/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA11.012d, Endovascular Grafts for Abdominal Aortic Aneurysms, Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Notification: 10/01/2019 | Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA12.003a, Acute Care Facility Inpatient Transfers
Notification: 12/02/2019 | Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA08.068d, Brentuximab Vedotin (Adcetris®)
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria

MA08.090b, Lanreotide (Somatuline® Depot)
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria

MA08.065e, Octreotide Acetate (Sandostatin® LAR Depot)
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.075d, Ramucirumab (Cyramza®)
Effective: 12/30/2019 | Posted: 12/30/2019

MA08.059f, Ipilimumab (Yervoy®)
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA10.001a, Pulmonary Rehabilitation Services
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: General Description, Guidelines, or Informational Update

MA08.001c, Vedolizumab (Entyvio®)
Effective: 12/30/2019 (Revised: 01/07/2020) | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria

MA08.102b, Mogamulizumab-kpkc (Poteligeo®)
Effective: 12/30/2019 | Posted: 12/30/2019
Type of policy change: Medical Necessity Criteria

MA10.007c, Speech Therapy
Effective: 01/01/2020 | Posted: 12/30/2019

MA08.007q, Medicare Part B vs. Part D Crossover Drugs
Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA08.016e, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA12.002b, Ground Ambulance Transport Services (Emergency and Nonemergency)
Notification: 12/02/2019 | Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA00.003m, Preventive Care Services
Notification: 12/02/2019 | Effective: 01/01/2020 (Revised: 01/22/2020) | Posted: 12/31/2019
Type of policy change: Medical Necessity Criteria; Medical Coding

MA12.007a, Air Ambulance Services
Notification: 12/02/2019 | Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.023i, Hyaluronan Acid Therapies for Osteoarthritis of the Knee
Notification: 10/03/2019 | Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

MA07.026e, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA00.026g, Always Bundled Procedure Codes
Effective: 01/01/2020 | Posted: 12/31/2019
Type of policy change: Medical Coding


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA09.009j, Reimbursement for Radiopharmaceutical Agents for Professional Providers
Reissue Effective: N/A | Reissue Posted: 12/02/2019

MA07.052, Bioimpedance for the Detection of Lymphedema
Reissue Effective: 12/05/2019 | Reissue Posted: 12/05/2019

MA08.056c, Eribulin Mesylate (Halaven®)
Reissue Effective: 12/05/2019 | Reissue Posted: 12/05/2019

MA06.022e, Biomarkers for Oncology
Reissue Effective: 12/05/2019 | Reissue Posted: 12/05/2019

MA07.042, Complete Decongestive Therapy (CDT)
Reissue Effective: 12/04/2019 | Reissue Posted: 12/06/2019

MA11.093a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 12/04/2019 | Reissue Posted: 12/06/2019

MA11.078b, Scar Revision
Reissue Effective: 12/04/2019 | Reissue Posted: 12/06/2019

MA07.035c, Transcranial Magnetic Stimulation (TMS)
Reissue Effective: 12/04/2019 | Reissue Posted: 12/06/2019

MA11.028e, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Reissue Effective: 12/18/2019 | Reissue Posted: 12/19/2019

MA11.006b, Bronchial Thermoplasty
Reissue Effective: 12/18/2019 | Reissue Posted: 12/19/2019

MA11.027c, Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)
Reissue Effective: 12/18/2019 | Reissue Posted: 12/19/2019

MA07.047f, Pain Management of Peripheral Nerves by Injection
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA07.001a, Hyperbaric Oxygen Therapy
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA05.047d, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA10.003e, Physical Medicine & Rehabilitation Services: Physical Therapy (PT) and Occupational Therapy (OT)
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA11.011c, Artificial Hearts and Ventricular Assist Devices (VADs)
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA11.052b, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA07.002c, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Reissue Effective: 12/18/2019 | Reissue Posted: 12/19/2019

MA11.062, Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA11.056e, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Reissue Effective: 12/19/2019 | Reissue Posted: 12/19/2019

MA02.002, Private Duty Nursing
Reissue Effective: 12/18/2019 | Reissue Posted: 12/20/2019


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.
MA07.007g, Pulmonary Function Tests
Effective: 01/01/2020 | Posted: 12/30/2019

MA05.066a, Cranial Electrotherapy Stimulation
Effective: 01/01/2020 | Posted: 12/30/2019

MA05.046e, Wheelchair Options and Accessories
Effective: 01/01/2020 | Posted: 12/30/2019

MA05.067b, Leadless Pacemakers
Effective: 01/01/2020 | Posted: 12/30/2019

MA05.033b, External Breast Prosthesis
Effective: 01/01/2020 | Posted: 12/30/2019

MA07.051f, Intraoperative Neurophysiological Testing
Effective: 01/01/2020 | Posted: 12/31/2019

MA08.108a, Polatuzumab Vedotin-Piiq (Polivy™)
Effective: 01/01/2020 | Posted: 12/31/2019

MA07.018b, Anorectal Manometry, Electromyography (EMG) of Anorectal or Urethral Sphincters; Biofeedback Training for Perineal Muscles and Anorectal or Urethral Sphincters
Effective: 01/01/2020 | Posted: 12/31/2019

MA07.024c, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Effective: 01/01/2020 | Posted: 12/31/2019

MA08.008d, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Nutrition (IPN)
Effective: 01/01/2020 | Posted: 12/31/2019

MA07.047g, Pain Management of Peripheral Nerves by Injection
Effective: 01/01/2020 | Posted: 12/31/2019

MA08.011e, Erythropoiesis Stimulating Agents (ESAs)
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.004g, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Effective: 01/01/2020 | Posted: 12/31/2019

MA10.003f, Physical Medicine & Rehabilitation Services: Physical Therapy (PT) and Occupational Therapy (OT)
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.077e, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.100e, Balloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.026e, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.102g, Denervation of the Spinal Nerves for Chronic Pain
Effective: 01/01/2020 | Posted: 12/31/2019

MA11.017f, Trigger Point Injections
Effective: 01/01/2020 | Posted: 12/31/2019


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA08.061, Belatacept (Nulojix®)
Notification: 12/02/2019 | Archive Effective: 01/01/2020 | Posted: 12/02/2019

MA08.055e, Histone Deacetylase Inhibitors for Peripheral T-cell Lymphoma (e.g., Istodax®, Beleodaq®)
Notification: 12/02/2019 | Archive Effective: 01/01/2020 | Posted: 12/02/2019

MA08.077d, Talimogene laherparepvec (Imlygic™)
Notification: 12/10/2019 | Archive Effective: 01/01/2020 | Posted: 12/10/2019

MA03.016, Insertion or Application of Urinary Catheters and the Associated Supplies Provided in the Office Setting
Notification: 12/13/2019 | Archive Effective: 01/13/2020 | Posted: 12/13/2019

MA03.015, Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)
Notification: 12/27/2019 | Archive Effective: 03/30/2020 | Posted: 12/27/2019










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