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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11.03.02r
Bariatric Surgery
11.03.02r
Attachment A (Body Mass Index (BMI) Charts) to 11.03.02r Bariatric Surgery
11.03.02r
Attachment B (Tanner Staging System Criteria for Adolescents) to 11.03.02r Bariatric Surgery
11.03.02r
Attachment C (ICD-10-CM codes) to 11.03.02r Bariatric Surgery
08.01.03c
Belatacept (Nulojix®)
08.00.99b
Belimumab (Benlysta®) for Intravenous Use
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08.00.66l
Bevacizumab (Avastin®) and Related Biosimilars
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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
07.00.01h
Biofeedback Therapy
07.06.03b
Bioimpedance for the Detection of Lymphedema
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11.05.02i
Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
08.01.21c
Blinatumomab (Blincyto®)
11.01.06e
Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
09.00.04i
Bone Mineral Density (BMD) Testing
08.00.73l
Bortezomib (Bortezomib for Injection, Velcade®)
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08.00.26u
Botulinum Toxin Agents
09.00.10z
Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy (Independence Administrators)
05.00.76b
Breast Pumps
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08.01.13c
Brentuximab Vedotin (Adcetris®)
11.16.07b
Bronchial Thermoplasty
08.01.49a
Burosumab-twza (Crysvita®)
08.00.96d
Cabazitaxel (Jevtana®)
08.01.51
Canakinumab (Ilaris®)
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10.01.01n
Cardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs
00.01.59e
Care Management and Care Planning Services
08.01.05f
Carfilzomib (Kyprolis™)
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00.10.15c
Cast and Splint Applications and Associated Supplies Provided in the Office Setting
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11.01.07d
Cataract Surgery
11.02.06l
Catheter Ablation of Cardiac Arrhythmias

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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.