Policy Bulletins
The Policy Bulletins listed below represent our catalogue of medical and claim payment policies. If you are looking for a specific type of policy, choose a category from the menu on the right. You may also use the search function in the top menu to search for policies by word or phrase.
   


Policy #
Policy Bulletin Title
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00.01.52h
Always Bundled Procedure Codes
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00.10.39j
Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
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00.10.38
Billing Requirements for Multiple Births for Professional Providers
00.01.59e
Care Management and Care Planning Services
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00.10.15c
Cast and Splint Applications and Associated Supplies Provided in the Office Setting
00.10.03i
Criteria for Reimbursement of Emergency Room Services
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00.03.02y
Diagnostic Radiology Services Included in Capitation
00.09.01e
Direct Access Obstetrics/Gynecology (OB/GYN)
00.01.19d
Facility Reporting of Observation Services
00.05.01e
Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program
00.10.37b
Humanitarian Use Devices (HUD) and the Humanitarian Device Exemption (HDE) Process
00.10.40c
Incident To and Non-Incident To Services Performed by Certified Registered Nurse Practitioners (CRNPs) and Physician Assistants (PAs)
00.01.47c
Inpatient Hospital Readmission
00.01.45
Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
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00.03.07w
Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.01.48c
Marijuana for Medical Use
00.10.31c
Medical Team Conferences
00.10.11k
Modifier 62: Two Surgeons
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00.10.17h
Modifier 66: Surgical Team
00.10.18j
Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
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00.01.60c
Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
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00.01.66b
Musculoskeletal Services (Independence)
00.01.56a
National Correct Coding Initiative (NCCI) Code Pair Edits
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00.01.44h
Never Events and Preventable Adverse Events
00.01.24h
Obsolete or Unreliable Diagnostic Tests and Medical Services
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00.03.10e
Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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00.03.03g
Outpatient Short-Term Rehabilitation Services Included in Capitation
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00.03.06e
Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
00.10.16d
Physician/Nonphysician Standby Services
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00.01.25at
PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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00.06.02z
Preventive Care Services (Independence)
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00.10.36p
Radiologic Guidance of a Procedure
00.01.18c
Reimbursement for Associated Services Performed in Conjunction with Dental Care
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00.01.61
Reimbursement for Components of Comprehensive Laboratory Panels
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00.01.14q
Reporting and Documentation Requirements for Anesthesia Services
00.01.49c
Reporting Requirements for Drugs and Biologics
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00.10.01ab
Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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00.01.41b
STAT Laboratory Tests Performed in the Outpatient Hospital Setting for Health Maintenance Organization (HMO) and Point of Service (POS) Products
00.10.41e
Telemedicine Services (Independence)
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00.03.09d
X-rays Associated with Fractures in the Office Setting

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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.