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.
05.00.35d, Foot Orthotics and Other Podiatric Appliances
Notification: 08/24/2016 | Effective: 10/01/2016 | Posted: 08/24/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

11.15.03h, Insertion of Implantable Infusion Pumps
Notification: 08/24/2016 | Effective: 09/23/2016 | Posted: 08/24/2016
Type of policy change: Medical Coding


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
06.02.51, Testing Serum Vitamin D Levels
Notification: 05/03/2016 | Effective: 08/01/2016 | Posted: 08/01/2016
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.
00.06.02q, Preventive Care Services
Notification: 07/01/2016 | Effective: 08/01/2016 | Posted: 08/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding

07.02.09d, Ambulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices
Notification: 07/01/2016 | Effective: 08/01/2016 | Posted: 08/01/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

07.03.09k, Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)
Notification: 06/02/2016 | Effective: 08/01/2016 | Posted: 08/01/2016
Type of policy change: Medical Coding

07.03.18j, Nerve Conduction Studies (NCS) and Related Electrodiagnostic Studies
Notification: 06/02/2016 | Effective: 08/01/2016 | Posted: 08/01/2016
Type of policy change: Medical Coding

08.00.92p, Coagulation Factors
Notification: 07/08/2016 | Effective: 08/08/2016 | Posted: 08/08/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.94h, Denosumab (Prolia ®, Xgeva®)
Effective: 08/10/2016 | Posted: 08/10/2016
Type of policy change: Medical Necessity Criteria; Medical Coding

11.02.16p, Ventricular Assist Devices (VADs)
Effective: 08/12/2016 | Posted: 08/12/2016
Type of policy change: Medical Coding; General Description, Guidelines, or Informational Update

07.03.07o, Evaluation and Management of Autism Spectrum Disorders (ASD)
Notification: 07/20/2016 | Effective: 08/19/2016 | Posted: 08/19/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

00.03.06b, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective: 08/22/2016 | Posted: 08/22/2016
Type of policy change: Coverage and/or Reimbursement Position

05.00.69b, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Effective: 08/24/2016 | Posted: 08/24/2016
Type of policy change: Medical Coding

11.08.02g, Reduction Mammoplasty
Effective: 08/24/2016 | Posted: 08/24/2016
Type of policy change: Medical Necessity Criteria; Medical Coding; General Description, Guidelines, or Informational Update

08.00.18k, Nutritional Formulas, Enteral Nutrition, Medical Foods, and Low-Protein Modified Food Products
Effective: 08/24/2016 | Posted: 08/24/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Necessity Criteria; General Description, Guidelines, or Informational Update

11.08.19l, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Effective: 08/26/2016 | Posted: 08/26/2016
Type of policy change: Coverage and/or Reimbursement Position; Medical Coding; General Description, Guidelines, or Informational Update

05.00.70b, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Notification: 07/27/2016 | Effective: 08/26/2016 | Posted: 08/26/2016


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.14.10n, Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.14.17d, Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.14.23c, Surgical Treatment of Femoroacetabular Impingement
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

08.01.22b, Alemtuzumab (Lemtrada™)
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.14.29, Spinal Discectomy
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.14.28, Spinal Laminectomy
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.14.26a, Surgical Treatments of Athletic Pubalgia
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

11.15.15e, Percutaneous Discectomy
Reissue Effective: 08/03/2016 | Reissue Posted: 08/03/2016

05.00.12f, Manual Wheelchairs
Reissue Effective: N/A | Reissue Posted: 08/04/2016

05.00.67l, Wheelchair Options and Accessories
Reissue Effective: 08/03/2016 | Reissue Posted: 08/04/2016

05.00.50k, Ostomy Supplies
Reissue Effective: 08/03/2016 | Reissue Posted: 08/04/2016

05.00.55h, Wheelchair Cushions and Seating
Reissue Effective: 08/03/2016 | Reissue Posted: 08/04/2016

08.00.22l, Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
Reissue Effective: 08/17/2016 | Reissue Posted: 08/17/2016

00.01.24f, Obsolete or Unreliable Diagnostic Tests and Medical Services
Reissue Effective: 08/17/2016 | Reissue Posted: 08/17/2016

08.01.12b, Repository Corticotropin (H.P. Acthar® Gel Injection)
Reissue Effective: 08/17/2016 | Reissue Posted: 08/17/2016

08.01.14d, Radium Ra 223 dichloride (Xofigo®) Injection (Independence Administrators)
Reissue Effective: 08/17/2016 | Reissue Posted: 08/17/2016

09.00.49h, Proton Beam Radiation Therapy (Independence Administrators)
Reissue Effective: 08/17/2016 | Reissue Posted: 08/18/2016

11.02.11f, Transcatheter Closure of Cardiac Septal Defects
Reissue Effective: 08/17/2016 | Reissue Posted: 08/18/2016

05.00.59h, Lower Limb Prostheses
Reissue Effective: 10/14/2015 | Reissue Posted: 08/19/2016

07.06.03b, Bioimpedance for the Detection of Lymphedema
Reissue Effective: 08/17/2016 | Reissue Posted: 08/19/2016

11.08.08g, Chemical Peels
Reissue Effective: 08/17/2016 | Reissue Posted: 08/19/2016

11.08.29d, Procedures for the Treatment of Acne
Reissue Effective: 08/17/2016 | Reissue Posted: 08/19/2016

11.14.21f, Microprocessor-Controlled Prostheses for Lower-Extremity Amputees
Reissue Effective: 08/17/2016 | Reissue Posted: 08/19/2016

11.02.13f, Transcoronary Ablation of Septal Hypertrophy (TASH)
Reissue Effective: 08/17/2016 | Reissue Posted: 08/22/2016


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.
00.01.59a, Care Management and Coordination Services
Effective: 07/01/2016 | Posted: 08/10/2016

00.01.25af, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective: 08/22/2016 | Posted: 08/22/2016


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