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

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.
07.03.25, Nonemergent Inpatient Video Electroencephalogram (EEG) Monitoring and Ambulatory EEG Monitoring in the Home
Notification: 03/30/2018 | Effective: 04/30/2018 | Posted: 03/30/2018
Type of policy change: This is a new policy.


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
07.03.26, Tumor Treating Fields
Effective: 03/23/2018 | Posted: 03/23/2018
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.
08.00.57m, Treatments for Complex Regional Pain Syndrome (CRPS)
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.03.05u, Sleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.09j, Denervation of the Spinal Nerves for Chronic Pain
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: General Description, Guidelines, or Informational Update

11.15.01s, Spinal Cord and Dorsal Root Ganglion Stimulation
Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: General Description, Guidelines, or Informational Update

00.01.66a, Musculoskeletal Services
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.23f, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
Notification: 12/01/2017 | Effective: 03/01/2018 | Posted: 03/01/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

05.00.08e, Continuous Passive Motion (CPM) Devices in the Home Setting
Effective: 03/07/2018 | Posted: 03/07/2018
Type of policy change: General Description, Guidelines, or Informational Update

08.01.15d, Golimumab (Simponi Aria®) Intravenous (IV) Injection
Effective: 03/07/2018 | Posted: 03/07/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.33l, Trastuzumab (Herceptin®) and Related Biosimilars
Effective: 03/09/2018 | Posted: 03/09/2018
Type of policy change: Medical Necessity Criteria

08.00.70c, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase™, Vimizim™, Naglazyme®, Mepsevii™, etc.)
Effective: 03/16/2018 | Posted: 03/16/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.02.10m, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Effective: 03/26/2018 | Posted: 03/26/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.11.02f, Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders
Effective: 03/26/2018 | Posted: 03/26/2018
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

11.02.17f, Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Effective: 03/26/2018 | Posted: 03/26/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

07.03.08g, Neuropsychological Testing for Neurologically Based Conditions
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 03/27/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.02.01p, Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 03/27/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.08.23i, Mohs' Micrographic Surgery
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 03/27/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.13.11h, Contact Lenses for the Treatment of Persistent (Corneal) Epithelial Defects
Notification: 12/27/2017 | Effective: 03/28/2018 | Posted: 03/28/2018
Type of policy change: General Description, Guidelines, or Informational Update

07.13.13b, Prescription Lenses and Visual Devices
Notification: 12/27/2017 | Effective: 03/28/2018 | Posted: 03/28/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.00.14f, Low-level Laser Therapy (LLLT)
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

05.00.61f, Cervical Traction Devices for In-home Use
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

07.13.01g, Orthoptic/Pleoptic Training
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

05.00.75, Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

11.06.02h, Elective Abortion
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

12.00.01e, Acupuncture
Reissue Effective: 03/14/2018 | Reissue Posted: 03/14/2018

05.00.78, Transtympanic Micropressure Device as a Treatment of Meniere's Disease
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

05.00.32i, Speech and Non-Speech Generating Devices
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.03.05c, Frenectomy or Frenotomy for Ankylogossia (Tongue-Tie)
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

05.00.25g, Cranial Remolding Orthoses (Helmets)
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.08.01f, Hair Transplants and Cranial Prostheses (Wigs)
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.01.07d, Cataract Surgery
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

08.00.99b, Belimumab (Benlysta®) for intravenous use
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.05.07d, Surgical Correction of Strabismus
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.05.01e, Refractive Keratoplasty
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.05.11c, Implantation of Intrastromal Corneal Ring Segments (ICRS)
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

11.05.08d, Photocoagulation of Macular Drusen
Reissue Effective: 03/28/2018 | Reissue Posted: 03/28/2018

07.00.03n, Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy
Reissue Effective: 03/28/2018 | Reissue Posted: 03/29/2018


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.
05.00.11h, Therapeutic Shoes and Orthopedic Shoes
Effective: 04/01/2018 | Posted: 03/30/2018

11.07.01r, Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)
Effective: 04/01/2018 | Posted: 03/30/2018

05.00.58j, Home Oxygen Therapy
Effective: 04/01/2018 | Posted: 03/30/2018

08.00.50q, Rituximab (Rituxan®) infusion, and rituximab and hyaluronidase human (Rituxan Hycela™) for subcutaneous injection
Effective: 04/01/2018 | Posted: 03/30/2018

08.00.34k, Infliximab and Related Biosimilars
Effective: 04/01/2018 | Posted: 03/30/2018

08.01.41a, Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
Effective: 04/01/2018 | Posted: 03/30/2018

08.00.92u, Coagulation Factors
Effective: 04/01/2018 | Posted: 03/30/2018

08.01.43b, Chimeric Antigen Receptor (CAR) Therapy
Effective: 04/01/2018 | Posted: 03/30/2018


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
11.02.13f, Transcoronary Ablation of Septal Hypertrophy (TASH)
Notification: 03/14/2018 | Archive Effective: 04/16/2018 | Posted: 03/14/2018

11.16.03f, Lung Volume Reduction Surgery
Notification: 03/16/2018 | Archive Effective: 04/16/2018 | Posted: 03/16/2018


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.