Commercial
Advanced Search
MPDocType
  
Title
  
MPPolicyNumber
  
MPNotificationIssuedDate
  
MPEffectiveDate
  
MPReissuedDate
  
MPArchiveNotifEffDate
  
MPSALogCreatedOn
  
MPPolicyChangeTypeslt
  
MPRevisionDate
  
MPSiteActivityRemovedDate
  
Updated PoliciesEpidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Independence Administrators)11.15.23l12/17/2024 12:00 PM3/17/20253/17/2025Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesApheresis Therapy06.03.04o12/17/2024 1:00 PM3/17/20253/17/2025Medical Necessity Criteria
Updated PoliciesHigh-Technology Radiology Services (Independence)09.00.46as3/23/20253/21/2025General Description, Guidelines, or Informational Update
Reissue PoliciesMarijuana for Medical Use00.01.48d7/12/20213/5/20253/5/2025
Reissue PoliciesModifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period03.00.15p7/12/20213/5/20253/5/2025
Reissue PoliciesModifier 79:  Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period03.00.28n9/13/20213/5/20253/5/2025
Reissue PoliciesLow Osmolar Contrast Agents09.00.31d12/30/20153/5/20253/5/2025
Reissue PoliciesModifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following the Initial Procedure for a Related Procedure During the Postoperative Period03.00.12g9/13/20213/5/20253/5/2025
Reissue Policiesolipudase alfa-rpcp (Xenpozyme®)08.01.96a4/1/20233/5/20253/5/2025
Reissue PoliciesTranscatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies07.05.06h10/1/20243/5/20253/5/2025
Reissue PoliciesBronchial Valves11.16.094/1/20223/5/20253/5/2025
Reissue PoliciesMagnetic Resonance Imaging (MRI) Contrast Agents09.00.45l10/1/20243/5/20253/5/2025
Reissue PoliciesModifier 53: Discontinued Procedure03.00.33b12/6/20213/5/20253/5/2025
Reissue PoliciesModifier 57:  Decision for Surgery03.00.16p6/21/20213/5/20253/5/2025
Reissue PoliciesAlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)06.02.29d7/1/20163/5/20253/5/2025
Reissue PoliciesGenetic Testing for Congenital Long QT Syndrome (Independence Administrators)06.02.31g1/1/20213/5/20253/5/2025
Reissue PoliciesAlloMap™ Molecular Expression Testing for Heart Transplant Rejection (Independence Administrators)06.02.29g7/1/20163/5/20253/5/2025
Reissue PoliciesMultigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)06.02.32d7/1/20163/5/20253/5/2025
Reissue PoliciesVectra® DA Blood Test for Rheumatoid Arthritis06.02.452/1/20163/5/20253/5/2025
Reissue PoliciesTildrakizumab-asmn (Ilumya®)08.01.48b2/24/20203/5/20253/5/2025
Reissue PoliciesEndometrial Ablation11.06.05f5/20/20193/5/20253/5/2025
Reissue PoliciesTalquetamab-tgvs (Talvey™)08.02.164/1/20243/5/20253/5/2025
Reissue PoliciesAcupuncture12.00.01i1/1/20253/5/20253/5/2025
Reissue PoliciesContrast Agents Used in Conjunction with Echocardiography09.00.11e5/3/20213/5/20253/5/2025
Reissue PoliciesRepair of Cleft Lip, Cleft Nose, and/or Cleft Palate11.03.01f12/21/20203/5/20253/5/2025
Reissue PoliciesAssays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)06.02.27p1/1/20253/5/20253/5/2025
Reissue PoliciesMolecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators)06.02.36d6/17/20193/5/20253/5/2025
Reissue PoliciesStem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic Conditions07.07.09j1/6/20253/5/20253/5/2025
Reissue PoliciesVeriStrat® Testing for Targeted Therapy in Non-Small Cell Lung Cancer06.02.49b5/6/20163/5/20253/5/2025
Reissue PoliciesDofetilide (Tikosyn®) Use in the Inpatient Setting08.00.49f3/11/20243/5/20253/5/2025
Reissue PoliciesUterine Artery Embolization11.06.04k5/20/20193/5/20253/5/2025
Reissue PoliciesLaparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis11.06.10a1/1/20243/5/20253/5/2025
Reissue PoliciesOvarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome11.06.07e1/1/20253/5/20253/5/2025
Reissue PoliciesElective Abortion11.06.02n7/1/20243/5/20253/5/2025
Reissue PoliciesNoncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System07.10.05n1/2/20243/5/20253/5/2025
Reissue PoliciesModifier 52: Reduced Services03.00.32b12/6/20213/5/20253/5/2025
Reissue PoliciesMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease08.01.93e1/1/20253/5/20253/5/2025
Reissue PoliciesPreimplantation Genetic Testing (Independence Administrators)06.02.24k1/1/20253/5/20253/5/2025
Reissue PoliciesIslet Cell Transplantation, including use of Donislecel-jujn (Lantidra)11.04.01e2/26/20243/5/20253/17/2025
Archived PoliciesTotal Artificial Hearts (TAHs)11.02.19g3/7/2025 11:00 AM4/7/20253/7/2025
Archived PoliciesOvarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome11.06.07e3/21/2025 9:00 AM4/21/20253/21/2025
Connect with Us

2025 Independence Blue Cross

Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.