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
03.02.12c
Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)
03.02.13f
Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)
03.12.04c
Insertion or Application of Urinary Catheters and the Associated Supplies Provided in the Office Setting
03.00.15n
Modifier 24: Unrelated Evaluation and Management Service by the Same Physician during a Postoperative Period
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03.00.06p
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
03.00.05i
Modifier 50: Bilateral Procedure
03.00.32
Modifier 52 Reduced Services
03.00.33
Modifier 53: Discontinued Procedure
03.00.16n
Modifier 57: Decision for Surgery
03.00.02a
Modifier 76: Repeat Procedure by Same Physician
03.00.11a
Modifier 77: Repeat Procedure by Another Physician
03.00.12e
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
03.00.28l
Modifier 79: Unrelated Procedure or Service by the Same Physician During the Postoperative Period
03.00.20i
Modifiers 26 (Professional Component) and TC (Technical Component)
03.00.31e
Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)
03.00.08d
Modifiers XE, XS, XP, XU, 59

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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.