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News & AnnouncementsCoverage of the COVID-19 Vaccination for Independence Commercial Members (Updated February 12, 2024. Retroactively Effective to January 1, 2024.)2/12/2024
New PoliciesEpcoritamab-bysp (EPKINLY™)08.02.122/12/20242/12/2024This is a New Policy.
New PoliciesPeroral Endoscopic Myotomy (POEM) Procedures11.03.172/19/20242/19/2024This is a New Policy.
Updated PoliciesCompression Garments05.00.37i1/1/20242/5/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesSpeech and Non-Speech Generating Devices05.00.32l2/5/20242/5/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesIslet Cell Transplantation, including use of Donislecel-jujn (Lantidra)11.04.01e2/26/20242/19/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesHyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies11.00.13j2/26/20242/26/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesMedical and Surgical Treatment of Temporomandibular Joint Disorder07.08.03i2/26/20242/26/2024Medical Coding
Updated PoliciesIsatuximab-irfc (Sarclisa®)08.00.46d2/26/20242/26/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesIntravenous Infliximab and Related Biosimilars08.00.34t2/26/20242/26/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesCetuximab (Erbitux®)08.00.67o2/26/20242/26/2024Medical Necessity Criteria
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors08.00.74v2/26/20242/26/2024Medical Necessity Criteria
Reissue PoliciesInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79i11/1/20232/7/20242/7/2024
Reissue PoliciesTriamcinolone Acetonide Extended-Release Injectable (Zilretta®)08.01.47a1/1/20192/7/20242/7/2024
Reissue PoliciesEquipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes05.00.05q7/1/20232/7/20242/7/2024
Reissue PoliciesShort-term Interstitial Continuous Glucose Monitoring Systems (CGMS)05.00.24s11/1/20232/7/20242/7/2024
Reissue PoliciesPegloticase (Krystexxa®)08.01.02h3/27/20232/7/20242/7/2024
Reissue PoliciesWireless Capsule Endoscopy for Gastrointestinal (GI) Disorders07.05.02r10/1/20232/7/20242/7/2024
Reissue PoliciesApplication and Removal of Tattoos11.08.05g7/20/20122/21/20242/21/2024
Reissue PoliciesRadioembolization for Primary and Metastatic Tumors of the Liver09.00.48g12/2/20192/21/20242/21/2024
Reissue PoliciesProteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)06.02.43b2/1/20172/21/20242/21/2024
Reissue PoliciesRapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders06.02.461/1/20232/21/20242/21/2024
Reissue PoliciesRadioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)08.00.08j3/4/20192/21/20242/21/2024
Reissue PoliciesCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)08.01.7111/30/20202/21/20242/21/2024
Reissue PoliciesExtracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions11.14.13h1/1/20222/21/20242/21/2024
Reissue PoliciesOrthognathic Surgery11.14.08d6/30/20172/21/20242/21/2024
Reissue PoliciesAlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)06.02.29d7/1/20162/21/20242/21/2024
Reissue PoliciesVeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer06.02.49b5/6/20162/21/20242/21/2024
Reissue PoliciesNoninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators)06.02.47e10/1/20212/21/20242/21/2024
Reissue PoliciesAcupuncture12.00.01h10/1/20232/21/20242/21/2024
Reissue PoliciesRadium Ra 223 dichloride (Xofigo®) Injection (Independence Administrators)08.01.14e3/1/20192/21/20242/21/2024
Reissue PoliciesCosmetic Procedures12.01.03b7/1/20232/21/20242/21/2024
Reissue PoliciesPercutaneous Intradiscal Annuloplasty (IDET/PIRFT)11.14.14e7/1/20132/21/20242/21/2024
Reissue PoliciesVectra® DA Blood Test for Rheumatoid Arthritis06.02.452/1/20162/21/20242/21/2024
Archived PoliciesMoxetumomab Pasudotox-tdfk (Lumoxiti™)08.01.53b1/31/2024 12:00 PM4/30/20242/23/2024