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.
00.01.61a, Reimbursement for Components of Comprehensive Laboratory Panels
Notification: 05/15/2020 | Effective: 06/15/2020 | Posted: 05/15/2020
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

09.00.46ab, High-Technology Radiology Services (Independence)
Notification: 05/18/2020 (Revised 07/01/2020) | Effective: 08/16/2020 | Posted: 05/18/2020
Type of policy change: Medical Necessity Criteria


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
08.00.45, Eptinezumab-jjmr (VYEPTI™)
Effective: 05/11/2020 | Posted: 05/11/2020
Type of policy change: This is a new policy.

08.00.46, Isatuximab-irfc (Sarclisa®)
Effective: 05/11/2020 | Posted: 05/11/2020
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.
05.00.35f, Foot Orthotics and Other Podiatric Appliances
Notification: 04/03/2020 | Effective: 05/04/2020 | Posted: 05/04/2020
Type of policy change: General Description, Guidelines, or Informational Update

08.01.22d, Alemtuzumab (Lemtrada®)
Effective: 05/04/2020 | Posted: 05/04/2020
Type of policy change: Medical Necessity Criteria

08.01.18e, Vedolizumab (Entyvio®)
Effective: 05/04/2020 | Posted: 05/04/2020
Type of policy change: General Description, Guidelines, or Informational Update

08.00.15f, Off-label Coverage for Prescription Drugs and/or Biologics
Effective: 05/04/2020 | Posted: 05/04/2020
Type of policy change: General Description, Guidelines, or Informational Update

08.00.33o, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Notification: 02/13/2020 | Effective: 05/15/2020 | Posted: 05/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.66n, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Notification: 02/13/2020 | Effective: 05/15/2020 | Posted: 05/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.00.50u, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Notification: 02/13/2020 | Effective: 05/15/2020 | Posted: 05/15/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.25ax, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 02/14/2020 | Effective: 05/18/2020 | Posted: 05/18/2020
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding

10.02.02j, Chiropractic Spinal and Extraspinal Manipulation Therapy
Notification: 02/18/2020 | Effective: 05/18/2020 | Posted: 05/18/2020
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

09.00.46aa, High-Technology Radiology Services (Independence)
Notification: 02/17/2020 | Effective: 05/17/2020 | Posted: 05/18/2020
Type of policy change: Medical Necessity Criteria

12.00.03g, Complementary and Integrative Health Services
Effective: 05/25/2020 | Posted: 05/26/2020
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.
08.00.57n, Treatments for Complex Regional Pain Syndrome (CRPS)
Reissue Effective: 05/20/2020 | Reissue Posted: 05/20/2020

11.08.01g, Hair Transplants and Cranial Prostheses (Wigs)
Reissue Effective: 05/20/2020 | Reissue Posted: 05/20/2020

08.00.55h, Omalizumab (Xolair®)
Reissue Effective: 05/20/2020 | Reissue Posted: 05/20/2020

08.01.02e, Pegloticase (Krystexxa®)
Reissue Effective: 05/21/2020 | Reissue Posted: 05/21/2020

08.01.47a, Triamcinolone Acetonide Extended-Release Injectable (Zilretta™)
Reissue Effective: 05/21/2020 | Reissue Posted: 05/21/2020

08.01.51, Canakinumab (Ilaris®)
Reissue Effective: 05/21/2020 | Reissue Posted: 05/21/2020


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
08.00.83h, Pralatrexate (Folotyn®) for Injection
Notification: 05/27/2020 | Archive Effective: 06/29/2020 | Posted: 05/27/2020


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