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

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.
08.00.66n, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Notification: 02/13/2020 (Revised 02/20/2020) | Effective: 05/15/2020 | Posted: 02/13/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.33o, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Notification: 02/13/2020 (Revised 02/20/2020) | Effective: 05/15/2020 | Posted: 02/13/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.50u, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Notification: 02/13/2020 (Revised 02/20/2020) | Effective: 05/15/2020 | Posted: 02/13/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.25aw, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 02/14/2020 (Revised 04/01/2020) | Effective: 05/18/2020 | Posted: 02/14/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

09.00.46aa, High-Technology Radiology Services (Independence)
Notification: 02/17/2020 | Effective: 05/17/2020 | Posted: 02/17/2020
Type of policy change: Medical Necessity Criteria

10.02.02j, Chiropractic Spinal and Extraspinal Manipulation Therapy
Notification: 02/18/2020 | Effective: 05/18/2020 | Posted: 02/18/2020
Type of policy change: Coverage and/or Reimbursement Position; 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.
08.01.59b, Polatuzumab Vedotin-Piiq (Polivy™)
Effective: 02/10/2020 | Posted: 02/10/2020
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.03.05w, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies (Independence)
Notification: 11/11/2019 | Effective: 02/09/2020 | Posted: 02/10/2020
Type of policy change: Medical Necessity Criteria

09.00.46z, High-Technology Radiology Services (Independence)
Notification: 11/11/2019 | Effective: 02/09/2020 | Posted: 02/10/2020
Type of policy change: Medical Necessity Criteria

11.15.03k, Implantable Infusion Pumps
Notification: 11/19/2019 | Effective: 02/17/2020 | Posted: 02/17/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.48b, Tildrakizumab-asmn (Ilumya™)
Effective: 02/24/2020 | Posted: 02/24/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.01.19f, Siltuximab (Sylvant®)
Effective: 02/24/2020 | Posted: 02/24/2020
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.05.02n, Wireless Capsule Endoscopy (WCE) as a Diagnostic Technique in Disorders of the Small Bowel, Esophagus, and Colon
Reissue Effective: 02/12/2020 | Reissue Posted: 02/13/2020

07.00.05g, In Vivo Allergy Sensitivity Testing
Reissue Effective: 02/12/2020 | Reissue Posted: 02/13/2020

07.00.21i, Allergy Immunotherapy
Reissue Effective: 02/12/2020 | Reissue Posted: 02/13/2020

01.00.09c, Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump
Reissue Effective: 02/12/2020 | Reissue Posted: 02/13/2020

06.02.26d, In Vitro Allergy Testing
Reissue Effective: 02/12/2020 | Reissue Posted: 02/13/2020

09.00.40d, Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)
Reissue Effective: 02/26/2020 | Reissue Posted: 02/27/2020

02.02.01g, Hospice Care
Reissue Effective: 02/12/2020 | Reissue Posted: 02/27/2020

09.00.42c, Computer-Aided Detection (CAD) System for Use with Chest Radiographs
Reissue Effective: 02/26/2020 | Reissue Posted: 02/27/2020

05.00.72f, Upper Limb Prostheses
Reissue Effective: 02/26/2020 | Reissue Posted: 02/27/2020

07.03.25a, Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home
Reissue Effective: 02/27/2020 | Reissue Posted: 02/27/2020

11.06.06e, Magnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation
Reissue Effective: 02/27/2020 | Reissue Posted: 02/27/2020

11.00.14f, Treatment of Twin-Twin Transfusion Syndrome (TTTS)
Reissue Effective: 02/27/2020 | Reissue Posted: 02/27/2020

07.10.04c, Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor
Reissue Effective: 02/26/2020 | Reissue Posted: 02/27/2020


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.