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

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Notifications
The following Independence Blue Cross commercial policies have been posted prior to their effective date.
09.00.32q, Diagnostic and Therapeutic Radiopharmaceutical Agents
Notification: 10/03/2016 | Effective: 01/01/2017 | Posted: 10/03/2016
Type of policy change: Coverage and/or Reimbursement Position

05.00.26d, Home Prothrombin Time Monitoring
Notification: 10/05/2016 | Effective: 11/04/2016 | Posted: 10/05/2016
Type of policy change: Medical Coding

10.01.01m, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs
Notification: 10/05/2016 | Effective: 11/04/2016 | Posted: 10/05/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

05.00.39m, Ankle-Foot/Knee-Ankle-Foot Orthoses
Notification: 10/20/2016 | Effective: 11/18/2016 | Posted: 10/20/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.07p, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Notification: 10/28/2016 | Effective: 11/28/2016 | Posted: 10/28/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Updated Policies
The following commercial 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.
00.01.14o, Reporting and Documentation Requirements for Anesthesia Services
Effective: 10/01/2016 | Posted: 10/03/2016

00.10.11i, Modifier 62: Two Surgeons
Effective: 10/01/2016 | Posted: 10/03/2016
Type of policy change: General Description, Guidelines, or Informational Update

11.02.19d, Total Artificial Hearts (TAHs)
Effective: 10/05/2016 | Posted: 10/05/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.76a, Breast Pumps
Effective: 10/05/2016 | Posted: 10/05/2016
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

10.03.01f, Physical Medicine, Rehabilitation, and Habilitation Services
Notification: 07/14/2016 | Effective: 10/12/2016 | Posted: 10/12/2016
Type of policy change: Coverage and/or Reimbursement Position

07.07.07f, Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
Effective: 10/12/2016 | Posted: 10/12/2016
Type of policy change: Medical Coding

07.00.14f, Low-level Laser Therapy (LLLT)
Notification: 09/14/2016 | Effective: 10/14/2016 | Posted: 10/14/2016

07.03.05s, Sleep Disorder Testing and Positive Airway Pressure Therapy
Notification: 09/14/2016 | Effective: 10/14/2016 | Posted: 10/14/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.52a, eviCore Lab Management Program
Effective: 10/15/2016 | Posted: 10/17/2016
Type of policy change: Medical Coding

08.00.83f, Pralatrexate (Folotyn®) for Injection
Effective: 10/19/2016 | Posted: 10/19/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

08.00.90f, Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound)/(Abraxane® for Injectable Suspension)
Effective: 10/19/2016 | Posted: 10/19/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
08.01.09c, Omacetaxine mepesuccinate (Synribo®)
Reissue Effective: 10/26/2016 | Reissue Posted: 10/27/2016

08.00.57i, Complex Regional Pain Syndrome (CRPS) Parenteral Treatments
Reissue Effective: 10/28/2016 | Reissue Posted: 10/28/2016

08.00.93e, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Reissue Effective: 10/26/2016 | Reissue Posted: 10/28/2016


Coding Update
The following commercial 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.
11.14.19j, Artificial Intervertebral Disc Insertion
Effective: 10/01/2016 | Posted: 10/01/2016

07.13.07h, Corneal Pachymetry Using Ultrasound
Effective: 10/01/2016 | Posted: 10/01/2016

07.08.03c, Medical and Surgical Treatment of Temporomandibular Joint Disorder
Effective: 10/01/2016 | Posted: 10/01/2016

10.02.02g, Chiropractic Spinal and Extraspinal Manipulation Therapy
Effective: 10/01/2016 | Posted: 10/01/2016

11.14.02k, Trigger Point Injections
Effective: 10/01/2016 | Posted: 10/01/2016

08.01.19d, Siltuximab (Sylvant®)
Effective: 10/01/2016 | Posted: 10/03/2016

11.08.29e, Procedures for the Treatment of Acne
Effective: 10/01/2016 | Posted: 10/03/2016

00.01.25ag, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 10/01/2016 | Posted: 10/03/2016

00.03.02v, Diagnostic Radiology Services Included in Capitation
Effective: 10/01/2016 | Posted: 10/03/2016

00.03.06c, 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
Effective: 10/01/2016 | Posted: 10/03/2016

11.06.09c, Labiaplasty
Effective: 10/01/2016 | Posted: 10/05/2016

11.09.02b, Sex Reassignment Surgery (SRS) for Gender Identity Disorder (GID)
Effective: 10/01/2016 | Posted: 10/14/2016


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