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.
02.01.02c, Private Duty Nursing
Notification: 03/09/2016 | Effective: 06/07/2016 | Posted: 03/09/2016
Type of policy change: Medical Necessity Criteria; 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
06.02.50, GPS Cancer™ Testing by NantHealth
Notification: 02/03/2016 | Effective: 03/01/2016 | Posted: 03/01/2016
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.
00.01.49b, Reporting Requirements for Drugs and Biologics
Notification: 12/31/2015 | Effective: 03/01/2016 | Posted: 03/01/2016

08.00.13q, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Notification: 12/02/2015 | Effective: 03/01/2016 | Posted: 03/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.78s, Self-Administered Drugs
Effective: 03/09/2016 | Posted: 03/09/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

05.00.32h, Speech and Non-Speech Generating Devices
Effective: 03/09/2016 | Posted: 03/09/2016

00.01.48b, Marijuana for Medical Use
Effective: 03/09/2016 | Posted: 03/09/2016

00.10.01v, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Effective: 03/18/2016 | Posted: 03/18/2016

08.00.84c, Eculizumab (Soliris®)
Effective: 03/23/2016 | Posted: 03/23/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.13a, Brentuximab Vedotin (Adcetris®)
Effective: 03/23/2016 | Posted: 03/23/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.05d, Carfilzomib (Kyprolis™)
Effective: 03/23/2016 | Posted: 03/23/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

06.02.27i, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis
Effective: 03/28/2016 | Posted: 03/28/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.08.01f, Non-Surgical Spinal Decompression Therapy
Effective: 03/28/2016 | Posted: 03/28/2016
Type of policy change: Medical Coding

08.00.57i, Complex Regional Pain Syndrome (CRPS) Parenteral Treatments
Notification: 12/30/2015 | Effective: 03/29/2016 | Posted: 03/29/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.03.07n, Evaluation and Management of Autism Spectrum Disorders (ASD)
Effective: 01/20/2016 | Posted: 03/30/2016
Type of policy change: Coverage and/or Reimbursement Position


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.05.08, Fecal Microbiota Transplantation (FMT)
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

07.03.10e, Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

07.00.02h, Intravenous Chelation Therapy
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

07.00.10h, Photodynamic Therapy (PDT) using Porfimer Sodium (Photofrin®)
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

11.03.15h, Gastric Electrical Stimulation (Enterra™), Gastric Pacing
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

11.04.01c, Islet Cell Transplantation
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

11.05.01c, Refractive Keratoplasty
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

11.07.02g, Sentinel Lymph Node Biopsy
Reissue Effective: 03/02/2016 | Reissue Posted: 03/03/2016

05.00.25f, Cranial Remolding Orthoses (Helmets)
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

04.00.03a, Dental Extractions Prior to Cardiac Surgery, Radiation Therapy, or Transplant Surgery
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

07.00.09d, Topical Oxygenation
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

08.00.51h, Enzyme Replacement for the Treatment of Gaucher's Disease
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

05.00.71b, Standing Frames
Notification: 01/01/2012 | Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

05.00.61e, Cervical Traction for In-home Use
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

09.00.51a, Positron Emission Mammography (PEM)
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

09.00.52d, Digital Breast Tomosynthesis (Independence)
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

08.00.72f, Alglucosidase alfa (e.g., Myozyme®, Lumizyme®)
Reissue Effective: 06/07/2017 | Reissue Posted: 03/16/2016

11.14.13f, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

11.08.01e, Hair Transplants and Cranial Prostheses (Wigs)
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

09.00.02e, Electron Beam Computed Tomography (EBCT) for Screening Evaluations
Reissue Effective: 03/30/2016 | Reissue Posted: 03/16/2016

05.00.60e, Pressure-Reducing Support Surfaces
Reissue Effective: 03/16/2016 | Reissue Posted: 03/16/2016

05.00.29h, Automatic External and Wearable Cardioverter Defibrillators
Reissue Effective: 03/16/2016 | Reissue Posted: 03/18/2016

06.02.17e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.09f, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.18j, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.29b, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.31d, Genetic Testing for Congenital Long QT Syndrome
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.37a, Immune Cell Function Assay
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

06.02.49a, VeriStrat® Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Reissue Effective: 03/16/2016 | Reissue Posted: 03/21/2016

07.13.05h, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Reissue Effective: 03/30/2016 | Reissue Posted: 03/30/2016

08.00.69a, Agalsidase beta (Fabrazyme®)
Reissue Effective: 03/30/2016 | Reissue Posted: 03/30/2016

11.02.26, Percutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation
Reissue Effective: 03/30/2016 | Reissue Posted: 03/30/2016

10.00.02b, Day Rehabilitation
Reissue Effective: 03/30/2016 | Reissue Posted: 03/30/2016

05.00.75, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Reissue Effective: 03/30/2016 | Reissue Posted: 03/31/2016

05.00.15o, Nebulizers
Reissue Effective: 03/30/2016 | Reissue Posted: 03/31/2016


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.
00.03.02u, Diagnostic Radiology Services Included in Capitation
Notification: 12/01/2015 | Effective: 03/01/2016 | Posted: 03/01/2016


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
00.01.13d, Infusion Therapy Services as Performed by Home Infusion Providers
Notification: 12/31/2015 | Archive Effective: 03/01/2016 | Posted: 03/01/2016

00.10.35g, Remote Patient Management: Telemedicine and Telehealth
Archive Effective: 03/16/2016 | Posted: 03/16/2016


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