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.
05.00.01j, Pneumatic Compression Therapy Devices
Notification: 04/06/2016 | Effective: 05/06/2016 | Posted: 04/06/2016

08.01.29, daratumumab (Darzalex)
Notification: 04/06/2016 | Effective: 05/06/2016 | Posted: 04/06/2016
Type of policy change: This is a new policy.

05.00.37f, Compression Garments
Notification: 04/06/2016 | Effective: 05/06/2016 | Posted: 04/06/2016


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.
00.10.18h, Modifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS
Effective: 04/01/2016 | Posted: 04/01/2016

11.06.05d, Endometrial Ablation
Effective: 04/01/2016 | Posted: 04/01/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

05.00.48i, Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
Notification: 12/31/2015 | Effective: 04/01/2016 | Posted: 04/01/2016

08.01.20d, Programmed Cell Death Receptor-1 (PD-1) Antagonists (e.g. Keytruda®, Opdivo®)
Effective: 04/06/2016 | Posted: 04/06/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.08.14h, Removal of Breast Implants
Effective: 04/06/2016 | Posted: 04/06/2016

11.17.06j, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Effective: 04/13/2016 | Posted: 04/13/2016
Type of policy change: Coverage and/or Reimbursement Position

11.00.14e, Treatment of Twin-Twin Transfusion Syndrome (TTTS)
Effective: 04/20/2016 | Posted: 04/20/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

08.01.02c, Pegloticase (Krystexxa®)
Effective: 04/20/2016 | Posted: 04/20/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

10.06.01j, Speech Therapy
Effective: 04/20/2016 | Posted: 04/20/2016
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.
07.10.04b, Parenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

05.00.65d, Home Uterine Activity Monitoring (HUAM) Devices
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

11.15.22c, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

05.00.47l, Knee Braces
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

12.00.01e, Acupuncture
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

05.00.43e, Seat Lift Mechanisms
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

05.00.31c, Pulse Oximetry Device in the Home Setting
Reissue Effective: 04/13/2016 | Reissue Posted: 04/13/2016

07.12.01d, Pelvic Floor Stimulation as a Treatment of Incontinence
Reissue Effective: 04/27/2016 | Reissue Posted: 04/28/2016

09.00.24c, Full-Body Computerized Tomography (CT) Scan Screening
Reissue Effective: 04/27/2016 | Reissue Posted: 04/28/2016

11.11.01h, Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Effective: 04/27/2016 | Reissue Posted: 04/28/2016

11.14.08c, Orthognathic Surgery
Reissue Effective: 04/27/2016 | Reissue Posted: 04/28/2016

06.02.45, Vectra® DA Blood Test for Rheumatoid Arthritis
Reissue Effective: 04/27/2016 | Reissue Posted: 04/29/2016


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.
11.14.07o, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Effective: 04/01/2016 | Posted: 04/01/2016

08.00.92o, Coagulation Factors for Hemophilia
Effective: 04/01/2016 | Posted: 04/01/2016

09.00.32o, Diagnostic and Therapeutic Radiopharmaceutical Agents
Effective: 04/01/2016 | Posted: 04/01/2016

08.00.93e, C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
Effective: 04/01/2016 | Posted: 04/01/2016

08.01.23a, Mepolizumab (Nucala®)
Effective: 04/01/2016 | Posted: 04/01/2016

08.01.27a, Talimogene laherparepvec (Imlygic™)
Effective: 04/01/2016 | Posted: 04/01/2016

00.01.25ad, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 04/15/2016 | Posted: 04/15/2016


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
11.05.17b, Implantable Miniature Telescope™ (IMT) for the Treatment of End-Stage, Age-Related Macular Degeneration (AMD)
Notification: 04/19/2016 | Archive Effective: 05/19/2016 | Posted: 04/19/2016

07.13.14a, The Argus® II Retinal Prosthesis
Notification: 04/19/2016 | Archive Effective: 05/19/2016 | Posted: 04/19/2016


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