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.
09.00.46u, High-Technology Radiology Services (Independence)
Notification: 08/01/2018 | Effective: 10/29/2018 | Posted: 08/01/2018
Type of policy change: General Description, Guidelines, or Informational Update

09.00.04i, Bone Mineral Density (BMD) Testing
Notification: 08/21/2018 | Effective: 11/19/2018 | Posted: 08/21/2018
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
08.01.49, Burosumab-twza (Crysvita®)
Effective: 08/13/2018 | Posted: 08/13/2018
Type of policy change: This is a new policy.

08.01.47, Triamcinolone Acetonide Extended-Release Injectable (Zilretta™)
Notification: 07/20/2018 | Effective: 08/20/2018 | Posted: 08/20/2018
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.
12.04.02g, Nonemergency Ambulance Transport Services
Effective: 08/13/2018 | Posted: 08/13/2018
Type of policy change: General Description, Guidelines, or Informational Update

08.01.04s, Immunizations
Effective: 09/03/2018 | Posted: 08/31/2018
Type of policy change: Medical Necessity Criteria


Reissue Policies
The following commercial policies have been reviewed, and no substantive changes were made.
11.03.01e, Repair of Cleft Lip, Cleft Nose, and/or Cleft Palate
Reissue Effective: 08/02/2018 | Reissue Posted: 08/02/2018

10.02.02h, Chiropractic Spinal and Extraspinal Manipulation Therapy
Reissue Effective: 08/01/2018 | Reissue Posted: 08/02/2018

05.00.73c, Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue Effective: 08/01/2018 | Reissue Posted: 08/02/2018

11.15.15g, Percutaneous Discectomy
Reissue Effective: 08/02/2018 | Reissue Posted: 08/02/2018

11.03.11n, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Reissue Effective: 08/01/2018 | Reissue Posted: 08/02/2018

08.00.22m, Immune Prophylaxis for Respiratory Syncytial Virus (RSV)
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

05.00.15p, Nebulizers and Inhalation Solutions
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

11.17.04r, Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

05.00.54g, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim Activated Power-Assist Devices
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

05.00.01l, Pneumatic Compression Therapy Devices
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

05.00.14h, High-Frequency Chest Wall Oscillation Devices
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

09.00.02e, Electron Beam Computed Tomography (EBCT) for Screening Evaluations
Reissue Effective: 08/15/2018 | Reissue Posted: 08/16/2018

05.00.67n, Wheelchair Options and Accessories
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

05.00.70b, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Reissue Effective: 08/16/2018 | Reissue Posted: 08/16/2018

00.01.45, Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.02.09g, Human Immunodeficiency Virus (HIV) Genotyping and Phenotyping (Independence Administrators)
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

00.05.01e, Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.02.31f, Genetic Testing for Congenital Long QT Syndrome (Independence Administrators)
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

00.01.19c, Facility Reporting of Observation Services
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.02.37a, Immune Cell Function Assay
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.02.38c, Nerve Fiber Density Testing
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.03.05e, Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

09.00.45g, Magnetic Resonance Imaging (MRI) Contrast Agents
Reissue Effective: 08/29/2018 | Reissue Posted: 08/29/2018

06.02.45, Vectra® DA Blood Test for Rheumatoid Arthritis
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

06.02.50, GPS Cancer™ Testing by NantHealth
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

11.14.01g, Mentoplasty or Genioplasty
Reissue Effective: 08/30/2018 | Reissue Posted: 08/30/2018

11.08.13g, Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty
Reissue Effective: 08/30/2018 | Reissue Posted: 08/30/2018

11.08.03j, Lipectomy and Liposuction
Reissue Effective: 08/30/2018 | Reissue Posted: 08/30/2018

06.02.17e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

06.02.49b, VeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

11.08.08g, Chemical Peels
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

06.02.18k, Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators)
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018

11.14.08d, Orthognathic Surgery
Reissue Effective: 08/30/2018 | Reissue Posted: 08/30/2018

06.02.55, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
Reissue Effective: 08/29/2018 | Reissue Posted: 08/30/2018


Archived Policies
Independence Blue Cross has determined that it is no longer necessary for the following commercial policy to remain active.
00.10.26d, Home Visits by a Physician
Notification: 08/10/2018 | Archive Effective: 09/10/2018 | Posted: 08/10/2018


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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.