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.
MA05.005d, Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Notification: 06/18/2020 | Effective: 07/20/2020 | Posted: 06/18/2020
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.
MA08.118, Sacituzumab govitecan-hziy (TrodelvyTM)
Effective: 06/22/2020 | Posted: 06/22/2020
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.
MA08.017e, Botulinum Toxin Agents
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.028d, Abatacept (Orencia®) for Injection for Intravenous Use
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

MA08.057b, Belimumab (Benlysta®) for Intravenous Use
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.007r, Medicare Part B vs. Part D Crossover Drugs
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Coverage and/or Reimbursement Position

MA08.045f, Tocilizumab (Actemra®) for Intravenous Infusion
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.105c, Tagraxofusp-erzs (Elzonris™)
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Medical Necessity Criteria

MA08.110a, Luspatercept–aamt (Reblozyl®)
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.065f, Octreotide Acetate (Sandostatin® LAR Depot)
Effective: 06/08/2020 | Posted: 06/08/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.081b, Meniscal Allograft Transplantation and Meniscal Implants
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.031h, Spinal Cord and Dorsal Root Ganglion Stimulation
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.029g, Spinal Discectomy
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.102h, Denervation of the Spinal Nerves for Chronic Pain
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA01.006a, Reimbursement for Components of Comprehensive Laboratory Panels
Notification: 05/15/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA11.044g, Artificial Intervertebral Disc Insertion
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: General Description, Guidelines, or Informational Update

MA11.026f, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.041c, Spinal Laminectomy
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA11.108d, Spinal Fusion
Notification: 03/11/2020 | Effective: 06/15/2020 | Posted: 06/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.078d, Sebelipase alfa (Kanuma®)
Effective: 06/22/2020 | Posted: 06/22/2020
Type of policy change: Coverage and/or Reimbursement Position

MA07.027c, Autonomic Nervous System Testing
Effective: 06/22/2020 | Posted: 06/22/2020
Type of policy change: Medical Coding


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA11.110, Surgery for Gynecomastia
Reissue Effective: 06/03/2020 | Reissue Posted: 06/03/2020

MA11.069b, Reduction Mammoplasty
Reissue Effective: 06/03/2020 | Reissue Posted: 06/03/2020

MA07.038e, Neuropsychological Testing for Neurologically Based Conditions
Reissue Effective: 06/03/2020 | Reissue Posted: 06/03/2020

MA11.112, Composite Tissue Allotransplantation of the Hand(s) and Face
Reissue Effective: 06/03/2020 | Reissue Posted: 06/05/2020

MA05.016f, Home Prothrombin Time Monitoring
Reissue Effective: 06/03/2020 | Reissue Posted: 06/05/2020

MA11.093a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 06/03/2020 | Reissue Posted: 06/05/2020

MA08.048d, Ofatumumab (Arzerra™)
Reissue Effective: 06/05/2020 | Reissue Posted: 06/05/2020

MA11.054c, Cataract Surgery
Reissue Effective: 06/05/2020 | Reissue Posted: 06/05/2020

MA08.103b, Moxetumomab pasudotox-tdfk (Lumoxiti™)
Reissue Effective: 06/05/2020 | Reissue Posted: 06/05/2020

MA08.011e, Erythropoiesis Stimulating Agents (ESAs)
Reissue Effective: 06/05/2020 | Reissue Posted: 06/05/2020

MA11.024d, Percutaneous Vertebroplasty and Percutaneous Vertebral Augmentation
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA11.084b, Osteochondral Autograft Transplantation Procedure
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA11.090, Surgical Treatment of Femoroacetabular Impingement
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA11.086b, Osteochondral Allograft Transplantation
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA05.018a, Osteogenic Stimulators (i.e., Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated Fracture Healing System)
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA11.082c, Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions
Reissue Effective: 06/15/2020 | Reissue Posted: 06/15/2020

MA11.021a, Non-Surgical Spinal Decompression Therapy
Reissue Effective: 06/17/2020 | Reissue Posted: 06/18/2020

MA10.005b, Day Rehabilitation
Reissue Effective: 06/18/2020 | Reissue Posted: 06/18/2020

MA08.088c, Ocrelizumab (Ocrevus®)
Reissue Effective: 06/17/2020 | Reissue Posted: 06/18/2020

MA10.001a, Pulmonary Rehabilitation Services
Reissue Effective: 06/18/2020 | Reissue Posted: 06/18/2020


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.
MA11.076d, Removal of Breast Implants
Effective: 06/08/2020 | Posted: 06/08/2020


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following Medicare Advantage policy to remain active.
MA02.001a, Hospice Care
Notification: 06/12/2020 | Archive Effective: 07/13/2020 | Posted: 06/12/2020

MA05.019a, Continuous Passive Motion (CPM) Devices in the Home Setting
Notification: 06/18/2020 | Archive Effective: 07/20/2020 | Posted: 06/18/2020










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