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

MA00.003h, Preventive Care Services
Notification: 09/29/2017; Revised 12/19/2017 | Effective: 01/01/2018 | Posted: 09/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

MA08.073e, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (e.g., ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®], and related biosimilars)
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 09/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.004h, Coagulation Factors
Notification: 09/29/2017 | Effective: 10/30/2017 | Posted: 09/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.090, Lanreotide (Somatuline® Depot)
Notification: 09/29/2017 | Effective: 01/01/2018 | Posted: 09/29/2017
Type of policy change: This is a new policy.


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.
MA08.089, Cerliponase alfa (Brineura™)
Notification: 08/09/2017 | Effective: 09/08/2017 | Posted: 09/08/2017
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.
MA09.020d, Radiation Therapy Services
Notification: 06/07/2017 | Effective: 09/01/2017 | Posted: 09/01/2017
Type of policy change: General Description, Guidelines, or Informational Update

MA08.010f, 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: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.079c, Daratumumab (Darzalex™)
Effective: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA08.059c, Ipilimumab (Yervoy®)
Effective: 09/06/2017 | Posted: 09/06/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

MA08.072b, Bevacizumab (Avastin®) and related biosimilars
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA08.065d, Octreotide Acetate (Sandostatin® LAR Depot)
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

MA05.002c, Hospital Beds and Accessories
Effective: 09/20/2017 | Posted: 09/20/2017
Type of policy change: General Description, Guidelines, or Informational Update

MA09.002e, High-Technology Radiology Services
Effective: 09/22/2017 | Posted: 09/22/2017
Type of policy change: General Description, Guidelines, or Informational Update

MA11.054b, Cataract Surgery
Effective: 09/27/2017 | Posted: 09/27/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

MA11.014c, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Notification: 06/29/2017 | Effective: 09/27/2017 | Posted: 09/27/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following Medicare Advantage policies have been reviewed, and no substantive changes were made.
MA11.079c, Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Effective: 09/13/2017 | Reissue Posted: 09/14/2017

MA07.014, Magnetic Pelvic Floor Stimulation (MPFS)
Reissue Effective: 09/27/2017 | Reissue Posted: 09/28/2017

MA11.016a, Prostate Mapping Biopsy
Reissue Effective: 09/27/2017 | Reissue Posted: 09/28/2017

MA08.053a, Personalized Vaccines (e.g., Provenge®)
Notification: 10/01/2014 | Reissue Effective: 09/28/2017 | Reissue Posted: 09/28/2017


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.
MA10.002b, Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.016b, Home Prothrombin Time Monitoring
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.020c, Therapeutic Shoes
Effective: 10/01/2017 | Posted: 09/29/2017

MA10.004d, Chiropractic Services
Effective: 10/01/2017 | Posted: 09/29/2017

MA11.001d, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Effective: 10/01/2017 | Posted: 09/29/2017

MA08.007h, Medicare Part B vs. Part D Crossover Drugs
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.004c, Pneumatic Compression Therapy Devices
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.015b, Home Blood Glucose Monitors and Supplies
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.004c, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.001a, High-Frequency Chest Wall Oscillation Devices
Effective: 10/01/2017 | Posted: 09/29/2017

MA10.003c, Physical Medicine & Rehabilitation Services: Physical Therapy (PT) and Occupational Therapy (OT)
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.009d, Routine Foot Care For Certain Medical Conditions
Effective: 10/01/2017 | Posted: 09/29/2017

MA00.010p, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.003c, Photodynamic Therapy Using Verteporfin (Visudyne®)
Effective: 10/01/2017 | Posted: 09/29/2017

MA00.002d, Continuous Glucose Monitors and Artificial Pancreas Device Systems (APDS)
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.006b, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.002c, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.006a, Fecal Microbiota Transplantation (FMT)
Effective: 10/01/2017 | Posted: 09/29/2017

MA08.088a, Ocrelizumab (Ocrevus™)
Effective: 10/01/2017 | Posted: 09/29/2017

MA08.016c, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Effective: 10/01/2017 | Posted: 09/29/2017

MA11.073b, Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin
Effective: 10/01/2017 | Posted: 09/29/2017

MA00.039b, Never Events and Preventable Adverse Events
Effective: 10/01/2017 | Posted: 09/29/2017

MA11.077c, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.023c, Upper Gastrointestinal Endoscopy (Diagnostic and Therapeutic)
Effective: 10/01/2017 | Posted: 09/29/2017

MA08.073d, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (e.g., ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], aflibercept [Eylea®])
Effective: 10/01/2017 | Posted: 09/29/2017

MA05.005b, Automatic External and Wearable Cardioverter Defibrillators
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.027a, Autonomic Nervous System Testing
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.050c, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Effective: 10/01/2017 | Posted: 09/29/2017

MA08.009d, Immune Globulin: Intravenous (IVIG), Subcutaneous (SCIG)
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.047d, Pain Management of Peripheral Nerves by Injection
Effective: 10/01/2017 | Posted: 09/29/2017

MA11.056d, Percutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting and Extracranial- Intracranial (EC-IC) Arterial Bypass Surgery
Effective: 10/01/2017 | Posted: 09/29/2017

MA07.007c, Pulmonary Function Tests
Effective: 10/01/2017 | Posted: 09/29/2017

MA00.033d, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Effective: 10/01/2017 | Posted: 09/29/2017










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