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.
08.00.98e, Eribulin Mesylate (Halaven®)
Notification: 12/26/2018 | Effective: 03/25/2019 | Posted: 12/26/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

10.00.03, Pediatric Intensive Day Feeding Program
Notification: 12/28/2018 | Effective: 01/28/2019 | Posted: 12/28/2018
Type of policy change: This is a new policy.

10.03.01j, Physical Medicine, Rehabilitation, and Habilitation Services
Notification: 12/28/2018 | Effective: 01/28/2019 | Posted: 12/28/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.75m, Erythropoiesis-Stimulating Agents (ESAs)
Notification: 12/28/2018 | Effective: 01/28/2019 | Posted: 12/28/2018
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
08.01.52, Mogamulizumab-kpkc (Poteligeo®)
Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: This is a new policy.

08.01.53, Moxetumomab Pasudotox-tdfk (Lumoxiti™)
Effective: 12/31/2018 | Posted: 12/31/2018
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.
08.01.28c, Sebelipase alfa (Kanuma®)
Notification: 09/04/2018 | Effective: 12/03/2018 | Posted: 12/03/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.00.10i, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Effective: 12/17/2018 | Posted: 12/17/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.36d, Nusinersen (Spinraza®)
Effective: 12/17/2018 | Posted: 12/17/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.88e, Ofatumumab (Arzerra™)
Effective: 12/17/2018 | Posted: 12/17/2018
Type of policy change: Medical Necessity Criteria

00.01.19d, Facility Reporting of Observation Services
Notification: 11/30/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position

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

08.01.02d, Pegloticase (Krystexxa®)
Notification: 10/01/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

00.01.14q, Reporting and Documentation Requirements for Anesthesia Services
Notification: 10/01/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position

06.02.52l, eviCore Lab Management Program (Independence)
Notification: 11/30/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.06.02x, Preventive Care Services (Independence)
Notification: 10/02/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.18m, Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk
Notification: 10/01/2018 | Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.90i, Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound) / (Abraxane® for Injectable Suspension)
Effective: 12/31/2018 | Posted: 12/31/2018
Type of policy change: Medical Necessity Criteria; Medical Coding

08.01.25c, Ramucirumab (Cyramza®)
Effective: 12/31/2018 | Posted: 12/31/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.78aa, Self-Administered Drugs
Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

08.00.92x, Coagulation Factors
Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.94j, Denosumab (Prolia®, Xgeva®)
Effective: 12/31/2018 | Posted: 12/31/2018
Type of policy change: Medical Necessity Criteria; Medical Coding

12.00.03f, Complementary and Integrative Health Services
Effective: 01/01/2019 | Posted: 12/31/2018
Type of policy change: General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.00.09f, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Reissue Effective: 12/05/2018 | Reissue Posted: 12/06/2018

11.00.02f, Treatment of Medical and Surgical Complications
Reissue Effective: 12/05/2018 | Reissue Posted: 12/06/2018

11.05.02i, Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
Reissue Effective: 12/05/2018 | Reissue Posted: 12/06/2018

08.00.96d, Cabazitaxel (Jevtana®)
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

05.00.39o, Ankle-Foot/Knee-Ankle-Foot Orthoses
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

07.03.05u, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

08.00.85g, Tocilizumab (Actemra®) for Intravenous Infusion
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

06.02.36b, PathFinderTG® (Independence Administrators)
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

09.00.42c, Computer-Aided Detection (CAD) System for Use with Chest Radiographs
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

11.03.02r, Bariatric Surgery
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

11.15.20n, Deep Brain Stimulation (DBS)
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018

05.00.59i, Lower Limb Prostheses
Reissue Effective: 12/19/2018 | Reissue Posted: 12/19/2018


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
11.14.11f, Arthroscopic Electrothermal Joint Repair
Notification: 12/28/2018 | Archive Effective: 01/28/2019 | Posted: 12/28/2018


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