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

Jul 2020  Jun 2020  May 2020  Apr 2020  Mar 2020  Feb 2020  Jan 2020  Dec 2019  Nov 2019  Oct 2019  Sep 2019  Aug 2019  Jul 2019  Jun 2019  May 2019  Apr 2019  Mar 2019  Feb 2019  Jan 2019  Dec 2018  Nov 2018  Oct 2018  Sep 2018  Aug 2018  Jul 2018  Jun 2018  May 2018  Apr 2018  Mar 2018  Feb 2018  Jan 2018  Dec 2017  Nov 2017  Oct 2017  Sep 2017  Aug 2017  Jul 2017  Jun 2017  May 2017  Apr 2017  Mar 2017  Feb 2017  Jan 2017  Dec 2016  Nov 2016  Oct 2016  Sep 2016  Aug 2016  Jul 2016  Jun 2016  May 2016  Apr 2016  Mar 2016  Feb 2016  Jan 2016  Dec 2015  Nov 2015  Oct 2015  Sep 2015  Aug 2015  Jul 2015  Jun 2015  

Notifications
The following Independence Blue Cross commercial policies have been posted prior to their effective date.
12.04.04, Acute Care Facility Inpatient Transfers
Notification: 11/02/2018 (Revised 11/12/2018) | Effective: 01/01/2019 | Posted: 11/02/2018
Type of policy change: This is a new policy.

12.04.02h, Ground Ambulance Transport Services (Emergency and Nonemergency)
Notification: 11/02/2018 | Effective: 01/01/2019 | Posted: 11/02/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

12.04.03c, Air Ambulance Services
Notification: 11/02/2018 | Effective: 01/01/2019 | Posted: 11/02/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.19d, Facility Reporting of Observation Services
Notification: 11/30/2018 | Effective: 01/01/2019 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position

09.00.49k, Proton Beam Radiation Therapy
Notification: 11/30/2018 | Effective: 03/01/2019 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

09.00.56h, Radiation Therapy Services (Independence)
Notification: 11/30/2018 (Revised 12/18/2018) | Effective: 03/01/2019 | Posted: 11/30/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.01.48a, Tildrakizumab-asmn (Ilumya™)
Notification: 11/30/2018 (Revised 12/06/2018) | Effective: 12/31/2018 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

06.02.52l, eviCore Lab Management Program (Independence)
Notification: 11/30/2018 (Revised 12/28/2018) | Effective: 01/01/2019 | Posted: 11/30/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


New Policies
The following commercial policies have been newly developed to communicate coverage and/or reimbursement positions, reporting requirements, and other processes and procedures for doing business with Independence Blue Cross
08.01.50, Patisiran (Onpattro™)
Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: This is a new policy.


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.
08.01.29d, Daratumumab (Darzalex™)
Effective: 11/05/2018 | Posted: 11/05/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

09.00.04i, Bone Mineral Density (BMD) Testing
Notification: 08/21/2018 | Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.35a, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: Medical Necessity Criteria

08.01.40a, Lanreotide (Somatuline® Depot)
Effective: 11/19/2018 | Posted: 11/19/2018
Type of policy change: Medical Necessity Criteria; Medical Coding

05.00.60g, Pressure-Reducing Support Surfaces
Effective: 11/26/2018 | Posted: 11/26/2018
Type of policy change: Medical Coding

00.01.52f, Always Bundled Procedure Codes
Effective: 11/26/2018 | Posted: 11/26/2018
Type of policy change: Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
08.00.95d, Personalized Vaccines (e.g. Provenge®)
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

08.00.49d, Dofetilide (Tikosyn®) Use in the Inpatient Setting
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

11.08.05g, Application and Removal of Tattoos
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

11.15.19e, Nucleoplasty
Reissue Effective: 11/07/2018 | Reissue Posted: 11/08/2018

00.10.41c, Telemedicine for Primary Care Services (Independence)
Reissue Effective: 11/08/2018 | Reissue Posted: 11/08/2018

07.03.10e, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

09.00.11c, Echocardiography Contrast Agents
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

00.10.16d, Physician/Nonphysician Standby Services
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

00.10.31c, Medical Team Conferences
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

03.02.13e, Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

03.00.33, Modifier 53: Discontinued Procedure
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.06o, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.10q, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

03.00.08d, Modifiers XE, XS, XP, XU, 59
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

03.00.31e, Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.24j, Preimplantation Genetic Testing (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

11.09.02e, Treatment of Gender Dysphoria
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

08.01.42, Edaravone (Radicava™)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

06.02.39b, Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.27k, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

07.03.21j, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

07.03.08h, Neuropsychological Testing for Neurologically Based Conditions
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

06.02.32d, Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.30e, Pharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

06.02.35s, Genetic Testing (Independence Administrators)
Reissue Effective: 11/26/2018 | Reissue Posted: 11/26/2018

08.00.17g, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
Reissue Effective: 11/21/2018 | Reissue Posted: 11/26/2018

06.02.43b, Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

07.00.21g, Allergy Immunotherapy
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

06.02.51c, Testing Serum Vitamin D Levels
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

06.02.44g, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

06.02.47b, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

09.00.17n, Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

08.01.12b, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

08.00.55h, Omalizumab (Xolair®)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

11.15.13d, Lysis of Epidural Adhesions
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

11.08.15u, Reconstructive Breast Surgery
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

08.00.82j, Ustekinumab (Stelara®)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018

11.14.14e, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Reissue Effective: 11/27/2018 | Reissue Posted: 11/27/2018


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.
11.03.02r, Bariatric Surgery
Effective: 10/01/2018 | Posted: 11/09/2018

11.03.12p, Colorectal Cancer Screening
Effective: 10/01/2018 | Posted: 11/09/2018

06.02.51c, Testing Serum Vitamin D Levels
Effective: 10/01/2018 | Posted: 11/09/2018

06.02.52k, eviCore Lab Management Program (Independence)
Effective: 10/01/2018 | Posted: 11/09/2018

06.02.35s, Genetic Testing (Independence Administrators)
Effective: 10/01/2018 | Posted: 11/09/2018

06.02.44g, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Effective: 10/01/2018 | Posted: 11/09/2018


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
11.11.05e, Circumcision
Notification: 11/02/2018 | Archive Effective: 12/03/2018 | Posted: 11/02/2018


Connect with Us        


© 2017 Independence Blue Cross.
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.