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
06.02.29d
AlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)
06.03.04n
Apheresis Therapy
06.02.27l
Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)
06.03.05e
Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
06.00.01e
Computer Analysis and Generation of Automated Data in Conjunction with Diagnostic Studies
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06.02.52l
eviCore Lab Management Program (Independence)
06.02.04d
Fetal Fibronectin Enzyme (fFN) Immunoassay
06.02.31f
Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
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06.02.06p
Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)
06.02.10q
Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)
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06.02.35t
Genetic Testing (Independence Administrators)
06.02.50
GPS Cancer™ Testing by NantHealth
06.02.09g
Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (Independence Administrators)
06.02.37a
Immune Cell Function Assay
06.02.26d
In Vitro Allergy Testing
06.02.14h
In Vitro Chemosensitivity and Chemoresistance Assays
06.02.01i
Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
06.02.39b
Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
06.02.32d
Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)
06.02.38d
Nerve Fiber Density Testing
06.02.47b
Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators)
06.02.56a
Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
06.02.36b
PathFinderTG® (Independence Administrators)
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06.02.30e
Pharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators)
06.02.18k
Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators)
06.02.24j
Preimplantation Genetic Testing (Independence Administrators)
06.02.44h
Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
06.02.43b
Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
06.02.17e
Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
06.02.51c
Testing Serum Vitamin D Levels
06.02.55
Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
06.02.45
Vectra® DA Blood Test for Rheumatoid Arthritis
06.02.49b
VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer

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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.