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.
11.00.06f, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
Notification: 4/23/2015 | Effective: 7/22/2015 | Posted: 06/10/2015
Type of policy change: Coverage and/or Reimbursement Position; (Notification revised on 6/10/2015.)

08.00.62f, Abatacept (Orencia®) for Injection for Intravenous Use
Notification: 6/17/2015 | Effective: 9/15/2015 | Posted: 06/17/2015
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.21, Blinatumomab (Blincyto™)
Notification: 6/3/2015 | Effective: 7/3/2015 | Posted: 06/03/2015
Type of policy change: This is a new policy.

05.00.56g, Hospital Beds and Accessories
Notification: 6/3/2015 | Effective: 7/3/2015 | Posted: 06/03/2015
Type of policy change: Medical Necessity Criteria

08.00.74h, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists (eg, ranibizumab [Lucentis®], pegaptanib sodium [Macugen®], and aflibercept [Eylea®]
Notification: 6/15/2015 | Effective: 7/15/2015 | Posted: 06/15/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.47, Noninvasive Prenatal Testing for Fetal Aneuploidies Using Cell-Free Fetal DNA
Notification: 6/15/2015 | Effective: 7/15/2015 | Posted: 06/15/2015
Type of policy change: This is a new policy.

11.14.07m, Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
Notification: 6/3/2015 | Effective: 9/1/2015 | Posted: 06/03/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria ; General Description, Guidelines, or Informational Update

06.02.27g, Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis
Notification: 6/15/2015 | Effective: 7/15/2015 | Posted: 06/15/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


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.
11.06.09b, Labiaplasty
Effective: 6/17/2015 | Posted: 06/17/2015
Type of policy change: Medical Necessity Criteria

11.00.03i, Fetal Surgery
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: Medical Coding

11.14.26a, Surgical Treatments of Athletic Pubalgia
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: General Description, Guidelines, or Informational Update

08.00.50n, Rituximab (Rituxan®)
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.18a, Vedolizumab (Entyvio®)
Notification: 3/25/2015 | Effective: 6/23/2015 | Posted: 06/23/2015
Type of policy change: Medical Necessity Criteria

11.08.15t, Reconstructive Breast Surgery
Effective: 6/19/2015 | Posted: 06/19/2015
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

11.08.20m, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Notification: 5/20/2015 | Effective: 6/19/2015 | Posted: 06/19/2015
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.01d, Ipilimumab (Yervoy®)
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.01.20a, Programmed Cell Death Receptor-1 (PD-1) antagonists (e.g. Keytruda ®, Opdivo)
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

12.01.01ac, Experimental/Investigational Services
Notification: 5/20/2015 | Effective: 6/19/2015 | Posted: 06/19/2015
Type of policy change: Medical Coding

11.05.16c, Aqueous Shunts, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Effective: 6/3/2015 | Posted: 06/03/2015
Type of policy change: Medical Necessity Criteria


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
05.00.31c, Pulse Oximetry Device in the Home Setting
Reissue Effective: 6/10/2015 | Reissue Posted: 06/11/2015

07.07.09e, Stem-Cell Therapy for Orthopedic Applications and Autologous Platelet-Derived Growth Factors (PDGFs)/Platelet-Rich Plasmas (PRPs) for Acute or Chronic Wound Healing and Other Miscellaneous Conditions
Reissue Effective: 06/24/2015 | Reissue Posted: 06/25/2015

00.10.37a, Humanitarian Use Devices (HUD) and the Humanitarian Device Exemption (HDE) Process
Reissue Effective: 06/24/2015 | Reissue Posted: 06/25/2015


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.
05.00.48h, Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
Effective: 6/1/2015 | Posted: 06/08/2015


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
00.01.51, Reporting of Healthcare Common Procedure Coding System (HCPCS) C Series Codes
Notification: 6/12/2015 | Archive Effective: 6/12/2015 | Posted: 06/12/2015

08.00.58c, Risperidone (Risperdal® Consta®) Injection
Notification: 6/17/2015 | Archive Effective: 07/17/2015 | Posted: 06/17/2015


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