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.
11.15.20l, Deep Brain Stimulation (DBS)
Notification: 05/02/2016 | Effective: 06/01/2016 | Posted: 05/02/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.52, eviCore Lab Management Program (Independence)
Notification: 05/02/2016 (updated 06/01/2016) | Effective: 07/01/2016 | Posted: 05/02/2016
Type of policy change: This is a new policy.

06.02.51, Testing Serum Vitamin D Levels
Notification: 05/03/2016 | Effective: 08/01/2016 | Posted: 05/03/2016
Type of policy change: This is a new policy.

05.00.42g, Patient Lifts
Notification: 05/04/2016 | Effective: 06/03/2016 | Posted: 05/04/2016

05.00.48j, Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
Notification: 05/31/2016 (archived on 6/29/2016) | Effective: 07/01/2016 | Posted: 05/31/2016


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
08.01.29, daratumumab (Darzalex)
Notification: 04/06/2016 | Effective: 05/06/2016 | Posted: 05/06/2016
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.
08.01.04n, Immunizations
Effective: 05/04/2016 | Posted: 05/04/2016
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.10b, Octreotide acetate (Sandostatin® LAR Depot)
Effective: 05/04/2016 | Posted: 05/04/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.64f, Natalizumab (Tysabri®)
Effective: 05/04/2016 | Posted: 05/04/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

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

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

11.06.02g, Elective Abortion
Effective: 05/13/2016 | Posted: 05/13/2016
Type of policy change: Medical Coding

08.00.97g, Histone Deacetylase Inhibitors for Peripheral T-cell Lymphoma (e.g., Istodax®, Beleodaq®)
Effective: 05/18/2016 | Posted: 05/18/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

00.01.48c, Marijuana for Medical Use
Effective: 05/18/2016 | Posted: 05/18/2016
Type of policy change: Medical Necessity Criteria

11.02.06k, Catheter Ablation of Cardiac Arrhythmias
Effective: 05/18/2016 | Posted: 05/18/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

08.01.19c, Siltuximab (Sylvant®)
Effective: 05/18/2016 | Posted: 05/18/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.08.12h, Surgery for Gynecomastia
Effective: 05/18/2016 | Posted: 05/18/2016
Type of policy change: Medical Coding

11.16.08a, Implantable Steroid-Eluting Sinus Stents
Effective: 05/20/2016 | Posted: 05/20/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.24l, Interstitial Continuous Glucose Monitoring Systems (CGMSs) and Artificial Pancreas Device Systems (APDS)
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

11.11.05e, Circumcision
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

07.13.06g, Scanning Computerized Ophthalmic Diagnostic Imaging (SCODI)
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

11.05.08c, Photocoagulation of Macular Drusen
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

11.02.17e, Endovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

07.11.01b, Smell and Taste Dysfunction Testing
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

11.00.16e, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

11.15.24a, Migraine Deactivation Surgery
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016

08.00.96c, Cabazitaxel (Jevtana®)
Reissue Effective: 05/11/2016 | Reissue Posted: 05/11/2016


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.
06.02.49b, VeriStrat® Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Effective: 05/06/2016 | Posted: 05/06/2016

06.02.14h, In Vitro Chemosensitivity and Chemoresistance Assays
Effective: 05/06/2016 | Posted: 05/06/2016

06.02.29c, AlloMap™ Molecular Expression Testing for Heart Transplant Rejection
Effective: 05/06/2016 | Posted: 05/06/2016

00.01.14n, Reporting and Documentation Requirements for Anesthesia Services
Effective: 01/01/2016 | Posted: 05/20/2016

11.00.10t, Multiple Surgical Reduction Guidelines
Effective: 01/01/2016 | Posted: 05/20/2016


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: 05/19/2016

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


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