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.
06.02.52e, eviCore Lab Management Program (Independence)
Notification: 06/01/2017 | Effective: 07/03/2017 | Posted: 06/01/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.08.06h, Panniculectomy, Abdominoplasty, and Other Excisions of Redundant Skin
Notification: 06/07/2017 | Effective: 07/07/2017 | Posted: 06/07/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

09.00.56d, Radiation Therapy Services (Independence)
Notification: 06/07/2017 | Effective: 09/01/2017 | Posted: 06/07/2017
Type of policy change: General Description, Guidelines, or Informational Update

05.00.32i, Speech and Non-Speech Generating Devices
Notification: 06/28/2017 | Effective: 07/28/2017 | Posted: 06/28/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

05.00.01k, Pneumatic Compression Therapy Devices
Notification: 06/28/2017 | Effective: 07/28/2017 | Posted: 06/28/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.07.01l, Routine Foot Care for Certain Medical Conditions
Notification: 06/29/2017 | Effective: 09/27/2017 | Posted: 06/29/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.08.17g, Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Notification: 06/29/2017 | Effective: 09/27/2017 | Posted: 06/29/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.01.25al, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.07q, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.10c, Obstetrical Ultrasounds for Members enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) product
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.10.40a, Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNP)
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.03.09c, X-rays Associated with Fractures in the Office Setting
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

00.10.01w, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Notification: 06/30/2017 | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; General Description, Guidelines, or Informational Update

08.00.13s, Immune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Notification: 06/30/2017 (revised 09/18/2017) | Effective: 10/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

06.02.44c, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Notification: 06/30/2017 (Revised 07/20/2017) | Effective: 08/01/2017 | Posted: 06/30/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; 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
11.14.30, Composite Tissue Allotransplantation of the Hand(s) and Face
Notification: 05/03/2017 | Effective: 06/02/2017 | Posted: 06/02/2017
Type of policy change: This is a new policy.

12.01.03, Cosmetic Procedures
Effective: 07/01/2017 | Posted: 06/30/2017
Type of policy change: This is a new policy.

12.01.02, Medical Necessity
Effective: 07/01/2017 | Posted: 06/30/2017
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.
11.15.20n, Deep Brain Stimulation (DBS)
Effective: 06/09/2017 | Posted: 06/09/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.15.16l, Vagus Nerve Stimulation (VNS)
Effective: 06/09/2017 | Posted: 06/09/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

11.05.08d, Photocoagulation of Macular Drusen
Effective: 06/14/2017 | Posted: 06/14/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

08.00.67j, Cetuximab (Erbitux®)
Effective: 06/14/2017 | Posted: 06/14/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

11.03.01e, Repair of Cleft Lip, Cleft Nose, and/or Cleft Palate
Effective: 06/16/2017 | Posted: 06/16/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

07.13.01g, Orthoptic/Pleoptic Training
Effective: 06/28/2017 | Posted: 06/28/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

07.03.15d, Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)
Effective: 06/28/2017 | Posted: 06/28/2017
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

09.00.04h, Bone Mineral Density (BMD) Testing
Effective: 07/01/2017 | Posted: 06/30/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.14.01g, Mentoplasty or Genioplasty
Effective: 06/30/2017 | Posted: 06/30/2017
Type of policy change: General Description, Guidelines, or Informational Update

11.05.02h, Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy
Effective: 06/30/2017 | Posted: 06/30/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.06.02t, Preventive Care Services (Independence)
Notification: 05/31/2017 | Effective: 07/01/2017 | Posted: 06/30/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

11.14.08d, Orthognathic Surgery
Effective: 06/30/2017 | Posted: 06/30/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.04p, Immunizations
Effective: 07/01/2017 | Posted: 06/30/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.00.21g, Allergy Immunotherapy
Reissue Effective: 06/12/2016 | Reissue Posted: 06/12/2017

07.00.09d, Topical Oxygenation
Reissue Effective: 06/12/2017 | Reissue Posted: 06/12/2017

07.07.07f, Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds
Reissue Effective: 06/12/2017 | Reissue Posted: 06/12/2017

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: 06/12/2017 | Reissue Posted: 06/12/2017

11.05.07d, Surgical Correction of Strabismus
Reissue Effective: 06/07/2017 | Reissue Posted: 06/12/2017

11.05.11c, Implantation of Intrastromal Corneal Ring Segments (ICRS)
Reissue Effective: 06/07/2017 | Reissue Posted: 06/12/2017

08.01.28b, Sebelipase alfa (Kanuma®)
Reissue Effective: 06/07/2017 | Reissue Posted: 06/12/2017

08.00.72f, Alglucosidase alfa (e.g., Myozyme®, Lumizyme®)
Reissue Effective: 06/07/2017 | Reissue Posted: 06/12/2017

08.00.69a, Agalsidase beta (Fabrazyme®)
Reissue Effective: 06/07/2017 | Reissue Posted: 06/12/2017

11.08.08g, Chemical Peels
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

11.08.05g, Application and Removal of Tattoos
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

11.08.29e, Procedures for the Treatment of Acne
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

07.03.09l, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

07.03.14l, Intraoperative Neurophysiological Monitoring (INM)
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

07.07.05a, Whole-body Integumentary Photography and Dermatoscopy
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

07.03.21h, Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

07.03.18k, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Reissue Effective: 06/19/2017 | Reissue Posted: 06/19/2017

11.14.21f, Microprocessor-Controlled Prostheses for Lower-Extremity Amputees
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

05.00.59h, Lower Limb Prostheses
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

05.00.35d, Foot Orthotics and Other Podiatric Appliances
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

05.00.11f, Therapeutic Shoes and Orthopedic Shoes
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

11.02.19d, Total Artificial Hearts (TAHs)
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

07.13.07i, Corneal Pachymetry Using Ultrasound
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

11.02.16p, Ventricular Assist Devices (VADs)
Reissue Effective: 06/21/2017 | Reissue Posted: 06/21/2017

07.11.01b, Smell and Taste Dysfunction Testing
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017

11.15.19e, Nucleoplasty
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017

10.02.02g, Chiropractic Spinal and Extraspinal Manipulation Therapy
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017

10.04.01k, Pulmonary Rehabilitation
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017

07.03.03f, Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017

07.03.07p, Evaluation and Management of Autism Spectrum Disorders (ASD)
Reissue Effective: 06/23/2017 | Reissue Posted: 06/23/2017


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.
00.01.25ak, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 06/01/2017 | Posted: 06/01/2017

11.17.06l, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Effective: 07/01/2017 | Posted: 06/30/2017

08.01.00d, Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies
Effective: 07/01/2017 | Posted: 06/30/2017

06.03.04m, Apheresis Therapy
Effective: 07/01/2017 | Posted: 06/30/2017

08.01.36a, Nusinersen (Spinraza™)
Effective: 07/01/2017 | Posted: 06/30/2017

08.00.82h, Ustekinumab (Stelara®)
Effective: 07/01/2017 | Posted: 06/30/2017

07.10.05i, Noncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System
Effective: 07/01/2017 | Posted: 06/30/2017


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