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.
05.00.26g, Home Prothrombin Time Monitoring
Notification: 04/03/2018 | Effective: 07/02/2018 | Posted: 04/03/2018
Type of policy change: Medical Coding

05.00.24q, Short-term Interstitial Continuous Glucose Monitoring Systems (CGMSs)
Notification: 04/04/2018 | Effective: 05/07/2018 | Posted: 04/04/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

05.00.79a, Insulin Pumps and Long term Interstitial Continuous Glucose Monitoring Systems
Notification: 04/04/2018 | Effective: 05/07/2018 | Posted: 04/04/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.74c, Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Notification: 04/04/2018 | Effective: 05/07/2018 | Posted: 04/04/2018
Type of policy change: Medical Coding

07.13.05k, Photodynamic Therapy (PDT) Using Verteporfin (Visudyne®)
Notification: 04/04/2018 | Effective: 05/07/2018 | Posted: 04/04/2018
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.00.03j, Fetal Surgery
Notification: 04/04/2018 | Effective: 05/07/2018 | Posted: 04/04/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

05.00.47n, Knee Orthoses
Notification: 04/06/2018 | Effective: 05/07/2018 | Posted: 04/06/2018
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

06.02.01i, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
Notification: 04/18/2018 | Effective: 05/21/2018 | Posted: 04/18/2018
Type of policy change: Coverage and/or Reimbursement Position; 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
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: 04/30/2018
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.
07.03.08g, Neuropsychological Testing for Neurologically Based Conditions
Notification: 12/27/2017 | Effective: 03/27/2018 | Posted: 04/02/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.25aq, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 01/03/2018 | Effective: 04/01/2018 | Posted: 04/02/2018
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

12.01.01an, Experimental/Investigational Services
Notification: 01/02/2018 | Effective: 04/01/2018 | Posted: 04/02/2018
Type of policy change: Medical Coding

07.13.07j, Corneal Pachymetry Using Ultrasound
Effective: 04/02/2018 | Posted: 04/02/2018
Type of policy change: Medical Coding

11.00.16g, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Effective: 04/09/2018 | Posted: 04/09/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.07s, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Effective: 04/09/2018 | Posted: 04/09/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.23d, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra™)
Effective: 04/09/2018 | Posted: 04/09/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.36k, First-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers
Effective: 04/09/2018 | Posted: 04/09/2018
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

08.01.27c, Talimogene laherparepvec (Imlygic™)
Effective: 04/09/2018 | Posted: 04/09/2018
Type of policy change: Medical Necessity Criteria

11.06.07d, Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
Effective: 04/23/2018 | Posted: 04/23/2018
Type of policy change: General Description, Guidelines, or Informational Update

07.13.08e, Partial Coherence Interferometry
Effective: 04/23/2018 | Posted: 04/23/2018
Type of policy change: Medical Coding

08.01.36c, Nusinersen (Spinraza™)
Effective: 04/23/2018 | Posted: 04/23/2018
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.00.62h, Abatacept (Orencia®) for Injection for Intravenous Use
Effective: 04/23/2018 | Posted: 04/23/2018
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.14.24b, Manipulation Under Anesthesia
Effective: 04/30/2018 | Posted: 04/30/2018
Type of policy change: Medical Coding


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.69b, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

08.01.35, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

11.06.04j, Uterine Artery Embolization
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

11.14.22d, Spinal Decompression with Interspinous and Interlaminar Devices
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

11.15.22d, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

11.14.13g, Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions
Reissue Effective: 04/11/2018 | Reissue Posted: 04/12/2018

05.00.05k, Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.08.12h, Surgery for Gynecomastia
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.15.24a, Migraine Deactivation Surgery
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

05.00.29k, Automatic External Cardioverter Defibrillators (Wearable and Nonwearable)
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

05.00.42g, Patient Lifts
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

08.01.24, Deoxycholic Acid (Kybella™)
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

08.00.64f, Natalizumab (Tysabri®)
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

05.00.43f, Seat Lift Mechanisms
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.08.14i, Removal of Breast Implants
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.02.19e, Total Artificial Hearts (TAHs)
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.14.30, Composite Tissue Allotransplantation of the Hand(s) and Face
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

07.08.01f, Non-Surgical Spinal Decompression Therapy
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.14.17d, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

12.01.02, Medical Necessity
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018

11.14.26a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 04/25/2018 | Reissue Posted: 04/25/2018


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.
06.02.51b, Testing Serum Vitamin D Levels
Effective: 04/01/2018 | Posted: 04/02/2018

06.02.35q, Genetic Testing (Independence Administrators)
Effective: 04/01/2018 | Posted: 04/02/2018

06.02.52i, eviCore Lab Management Program (Independence)
Effective: 04/01/2018 | Posted: 04/02/2018


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