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.
11.16.01h, Septoplasty, Rhinoplasty, and Septorhinoplasty
Notification: 07/10/2017 | Effective: 10/10/2017 | Posted: 07/12/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

08.01.38, Ocrelizumab (Ocrevus™)
Notification: 07/24/2017 | Effective: 08/23/2017 | Posted: 07/24/2017
Type of policy change: This is a new policy.

08.00.51i, Enzyme Replacement for the Treatment of Gaucher's Disease
Notification: 07/26/2017 | Effective: 10/24/2017 | Posted: 07/26/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria


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.
11.03.05c, Frenectomy or Frenotomy for Ankylogossia (Tongue-Tie)
Notification: 04/06/2017 | Effective: 07/05/2017 | Posted: 07/05/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

06.02.52e, eviCore Lab Management Program (Independence)
Notification: 06/01/2017 | Effective: 07/03/2017 | Posted: 07/05/2017
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: 07/07/2017
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.96d, Cabazitaxel (Jevtana®)
Effective: 07/12/2017 | Posted: 07/12/2017
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria

08.01.15c, Golimumab (Simponi Aria®) Intravenous (IV) Injection
Effective: 07/12/2017 | Posted: 07/12/2017
Type of policy change: Medical Necessity Criteria; General Description, Guidelines, or Informational Update

08.01.09d, Omacetaxine mepesuccinate (Synribo®)
Effective: 07/12/2017 | Posted: 07/12/2017
Type of policy change: Medical Necessity Criteria

11.16.07b, Bronchial Thermoplasty
Effective: 07/14/2017 | Posted: 07/14/2017
Type of policy change: Medical Necessity Criteria; Medical Coding

12.01.01ak, Experimental/Investigational Services
Notification: 04/19/2017 | Effective: 07/18/2017 | Posted: 07/18/2017
Type of policy change: Coverage and/or Reimbursement Position

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


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
07.00.03n, Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.02.06k, Catheter Ablation of Cardiac Arrhythmias
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.02.13f, Transcoronary Ablation of Septal Hypertrophy (TASH)
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

07.02.05j, External Counterpulsation (ECP)
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.00.16e, Radiofrequency Ablation and Cryosurgical Ablation of Lung Tumors
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.16.03f, Lung Volume Reduction Surgery
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.16.08a, Implantable Steroid-Eluting Sinus Stents
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

10.01.01m, Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

11.15.03i, Insertion of Implantable Infusion Pumps
Reissue Effective: 07/17/2017 | Reissue Posted: 07/17/2017

07.06.03b, Bioimpedance for the Detection of Lymphedema
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

07.06.01b, Complete Decongestive Therapy (CDT)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.00.70b, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase™, Vimizim™, Naglazyme®, etc.)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

09.00.40d, Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

09.00.51a, Positron Emission Mammography (PEM)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

00.01.48c, Marijuana for Medical Use
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.01.27b, Talimogene laherparepvec (Imlygic™)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.00.91c, Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP™, Glassia™, Zemaira™)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.00.99b, Belimumab (Benlysta®)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.01.26, Pegademase bovine (Adagen®)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

08.01.35, Asparaginase Erwinia Chrysanthemi (Erwinaze®)
Reissue Effective: 07/18/2017 | Reissue Posted: 07/18/2017

06.02.04d, Fetal Fibronectin Enzyme (fFN) Immunoassay
Reissue Effective: 07/20/2017 | Reissue Posted: 07/20/2017

06.02.09g, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (Independence Administrators)
Reissue Effective: 07/25/2017 | Reissue Posted: 07/25/2017

06.02.14h, In Vitro Chemosensitivity and Chemoresistance Assays
Reissue Effective: 07/25/2017 | Reissue Posted: 07/25/2017

06.02.10p, Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)
Reissue Effective: 07/25/2017 | Reissue Posted: 07/25/2017

06.02.17e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.18k, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators)
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.36b, PathFinderTG® (Independence Administrators)
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.31f, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.32d, Multigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.37a, Immune Cell Function Assay
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.45, Vectra® DA Blood Test for Rheumatoid Arthritis
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.38c, Nerve Fiber Density Testing
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.47b, Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators)
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.50, GPS Cancer™ Testing by NantHealth
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017

06.02.49b, VeriStrat® Testing for Targeted Therapy in Non-Small-Cell Lung Cancer
Reissue Effective: 07/26/2017 | Reissue Posted: 07/26/2017


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.
12.00.03e, Complementary and Integrative Health Services
Effective: 07/01/2017 | Posted: 07/10/2017

11.06.06d, Magnetic Resonance Imaging (MRI)--Guided Focused Ultrasound Ablation
Effective: 07/01/2017 | Posted: 07/10/2017


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