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.
MA08.089, Cerliponase alfa (Brineura™)
Notification: 08/09/2017 | Effective: 09/08/2017 | Posted: 08/09/2017
Type of policy change: This is a new policy.

MA11.031e, Spinal Cord and Dorsal Root Ganglion Stimulation
Notification: 08/23/2017 | Effective: 11/21/2017 | Posted: 08/23/2017
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.
MA07.027, Autonomic Nervous System Testing
Notification: 05/03/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: This is a new policy.

MA08.088, Ocrelizumab (Ocrevus™)
Notification: 07/24/2017 | Effective: 08/23/2017 | Posted: 08/23/2017
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.
MA03.003c, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Notification: 05/01/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position

MA00.007c, Obstetrical Ultrasounds for members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA00.030h, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA06.025c, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA00.010n, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA00.045a, Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNP)
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA00.031c, X-rays Associated with Fractures in the Office Setting
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA00.033c, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 08/01/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

MA11.008b, Refractive Keratoplasty
Effective: 08/02/2017 | Posted: 08/02/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

MA07.021a, Partial Coherence Interferometry
Effective: 08/23/2017 | Posted: 08/23/2017
Type of policy change: Medical Coding

MA07.004b, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Effective: 02/27/2017 | Posted: 08/23/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.054d, Urological Supplies
Notification: 07/25/2017 | Effective: 08/25/2017 | Posted: 08/25/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA11.002d, Hematopoietic Stem Cell Transplantation
Effective: 08/25/2017 | Posted: 08/25/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA06.021c, In Vitro Chemosensitivity and Chemoresistance Assays
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA06.013b, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA06.014c, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA06.007b, Loss-of-Heterozygosity-Based Topographic Genotyping with PathFinderTG®
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA06.018a, Immune Cell Function Assay
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA06.023b, Nerve Fiber Density Testing
Reissue Effective: 08/07/2017 | Reissue Posted: 08/07/2017

MA07.041a, Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies
Reissue Effective: 08/09/2017 | Reissue Posted: 08/09/2017

MA06.031, Vitamin D Assay Testing
Reissue Effective: 08/09/2017 | Reissue Posted: 08/09/2017

MA07.040a, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Reissue Effective: 08/09/2017 | Reissue Posted: 08/09/2017

MA07.017b, Hyperthermic Intraperitoneal Chemotherapy (HIPEC)
Reissue Effective: 08/09/2017 | Reissue Posted: 08/09/2017

MA07.016a, Intravenous Chelation Therapy
Reissue Effective: 08/09/2017 | Reissue Posted: 08/09/2017

MA11.007, Islet Cell Transplantation
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA07.030a, Photodynamic Therapy (PDT) using Porfimer Sodium (Photofrin®)
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA11.068a, Sentinel Lymph Node Biopsy
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA07.006, Fecal Microbiota Transplantation (FMT)
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA07.039a, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA11.077b, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA08.028b, Abatacept (Orencia®) for Injection for Intravenous Use
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA08.061, Belatacept (Nulojix®)
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA08.051c, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Reissue Effective: 08/10/2017 | Reissue Posted: 08/10/2017

MA08.067a, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA08.046, Ecallantide (Kalbitor®)
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA08.021a, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA08.045c, Tocilizumab (Actemra®) for Intravenous Infusion
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA08.008c, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Nutrition (IPN)
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA05.016a, Home Prothrombin Time Monitoring
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA05.023, Wheelchair Cushions and Seating
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA05.031a, Patient Lifts
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA05.046b, Wheelchair Options and Accessories
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA05.017a, Home Oxygen Therapy
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA11.021a, Non-Surgical Spinal Decompression Therapy
Reissue Effective: 08/24/2017 | Reissue Posted: 08/24/2017

MA07.024a, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

MA11.017c, Trigger Point Injections
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

MA11.081, Meniscal Allograft Transplantation
Reissue Effective: 08/28/2017 | Reissue Posted: 08/28/2017

MA11.025, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.085a, Arthroscopic Electrothermal Joint Repair
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.087b, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.048b, Lumbar Interspinous Process Decompression System
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.044c, Artificial Intervertebral Disc Insertion
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.088b, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.096a, Percutaneous Discectomy
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.090, Surgical Treatment of Femoroacetabular Impingement
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.091a, Manipulation Under Anesthesia
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.093a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.029b, Spinal Discectomy
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA08.024c, Interleukin-5 Antagonist for Severe Eosinophilic Asthma (e.g., Nucala®, Cinqair®)
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA11.097b, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 08/29/2017 | Reissue Posted: 08/29/2017

MA08.012a, Off-label Coverage for Prescription Drugs and/or Biologics
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

MA05.031a, Patient Lifts
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

MA05.011a, Seat Lift Mechanisms
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

MA11.027c, Transcatheter Aortic Valve Replacement (TAVR) and Transcatheter Mitral Valve Repair (TMVR)
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017

MA05.014a, Ostomy Supplies
Reissue Effective: 08/30/2017 | Reissue Posted: 08/30/2017


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.
MA06.017i, Molecular Diagnostics
Effective: 08/01/2017 | Posted: 08/01/2017

MA00.030i, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 08/01/2017 | Posted: 08/21/2017

MA00.010o, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 08/21/2017 | Posted: 08/21/2017










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