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News & AnnouncementsNotification of Policy Update to Policy #00.06.02ar: Preventive Care Services Applicable to Independence Commercial Members4/2/2024
News & Announcements4/01/2024 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products4/23/2024
NotificationsEvinacumab-dgnb (Evkeeza®) 08.01.76c4/24/2024 10:00 AM5/27/20244/24/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
New PoliciesTalquetamab-tgvs (Talvey™)08.02.164/1/20244/1/2024This is a New Policy.
New PoliciesPozelimab-bbfg (Veopoz TM)08.02.174/1/20244/1/2024This is a New Policy.
New PoliciesElranatamab-bcmm (Elrexfio™) 08.02.184/22/20244/22/2024This is a New Policy.
Updated PoliciesNatalizumab (Tysabri®) and Related Biosimilars08.00.64h4/1/20244/1/2024Medical Necessity Criteria
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors08.00.74w4/1/20244/1/2024Medical Necessity Criteria
Updated PoliciesRadiation Therapy Services (Independence Administrators)09.00.56r4/8/20244/8/2024Medical Necessity Criteria
Updated PoliciesAnkle-Foot/Knee-Ankle-Foot Orthoses05.00.39u4/8/20244/8/2024General Description, Guidelines, or Informational Update
Updated PoliciesKnee Orthoses05.00.47r3/8/2024 10:00 AM4/8/20244/8/2024General Description, Guidelines, or Informational Update
Updated PoliciesMosunetuzumab-axgb (Lunsumio™)08.02.00b4/8/20244/8/2024Medical Necessity Criteria
Updated PoliciesTisotumab vedotin-tftv (Tivdak®)08.01.83c4/8/20244/8/2024Medical Necessity Criteria
Updated PoliciesEfbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars08.01.32l4/8/20244/8/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery11.02.12k4/8/20244/8/2024Medical Necessity Criteria
Updated PoliciesTeclistamab-cqyv (Tecvayli®)08.01.98c4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesNivolumab and Relatlimab-rmbw (Opdualag™) 08.01.94c4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPertuzumab (Perjeta®)08.01.07j4/8/20244/8/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesPemetrexed (Pemfexy™)08.00.87m4/8/20244/8/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)08.00.43f4/8/20244/8/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesHigh-Technology Radiology Services (Independence)09.00.46aq4/14/20244/15/2024General Description, Guidelines, or Informational Update
Updated PoliciesMusculoskeletal Services (Independence)00.01.66l4/14/20244/15/2024Medical Necessity Criteria
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bn4/1/20244/19/2024Coverage and/or Reimbursement Position
Updated PoliciesCochlear Implantation11.01.02r4/22/20244/22/2024General Description, Guidelines, or Informational Update
Updated PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids11.01.06i4/22/20244/22/2024General Description, Guidelines, or Informational Update
Updated PoliciesErythropoiesis-Stimulating Agents (ESAs)08.00.75p4/22/20244/22/2024Medical Necessity Criteria;Medical Coding
Updated PoliciesInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79j4/22/20244/22/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPressure-Reducing Support Surfaces05.00.60k4/22/20244/22/2024Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesAlglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )08.00.72l4/22/20244/22/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease08.01.93c7/7/20234/23/2024Medical Coding;General Description, Guidelines, or Informational Update
Reissue PoliciesPulse Oximetry Devices in the Home Setting05.00.31e5/7/20184/3/20244/3/2024
Reissue PoliciesComposite Tissue Allotransplantation of the Hand(s) and Face11.14.305/19/20174/3/20244/3/2024
Reissue PoliciesPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)08.01.72a3/21/20224/3/20244/3/2024
Reissue PoliciesTebentafusp-tebn (Kimmtrak®)08.01.85b10/1/20224/3/20244/3/2024
Reissue PoliciesIntensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)09.00.17q11/6/20234/3/20244/3/2024
Reissue PoliciesHospital Beds and Accessories05.00.56l4/17/20234/3/20244/3/2024
Reissue PoliciesIntensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)09.00.17q11/6/20234/3/20244/8/2024
Reissue PoliciesAcute Care Facility Inpatient Transfers12.04.04b1/1/20234/17/20244/17/2024
Reissue PoliciesPharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators)06.02.30f1/1/20234/17/20244/17/2024
Reissue PoliciesProteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)06.02.43b2/1/20174/17/20244/17/2024
Reissue PoliciesLabiaplasty11.06.09d5/14/20184/17/20244/17/2024
Reissue PoliciesOcrelizumab (Ocrevus®)08.01.38c9/17/20194/17/20244/17/2024
Reissue PoliciesCoronary Artery Calcium (CAC) Testing Using Computed Tomography (Independence Administrators)09.00.588/14/20234/17/20244/17/2024
Reissue PoliciesAutonomic Nervous System Testing07.03.23f10/1/20224/17/20244/17/2024
Reissue PoliciesManual Wheelchairs05.00.12j4/13/20234/17/20244/17/2024
Reissue PoliciesPharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators)06.02.18m1/1/20234/17/20244/17/2024
Reissue PoliciesPreimplantation Genetic Testing (Independence Administrators)06.02.24j10/1/20164/17/20244/17/2024
Reissue PoliciesMultigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)06.02.32d7/1/20164/17/20244/17/2024
Reissue PoliciesFull-Body Computerized Tomography (CT) Scan Screening09.00.24c3/25/20154/17/20244/17/2024
Reissue PoliciesPercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis11.15.22d1/1/20174/17/20244/17/2024
Reissue PoliciesMigraine Deactivation Surgery11.15.24a3/11/20154/17/20244/17/2024
Reissue PoliciesAlemtuzumab (Lemtrada®)08.01.22d5/4/20204/17/20244/17/2024
Reissue PoliciesColorectal Cancer Screening11.03.12t7/1/20214/17/20244/17/2024
Reissue PoliciesHuman Immunodeficiency Virus (HIV) Genotyping and Phenotyping (Independence Administrators)06.02.09g7/1/20164/17/20244/17/2024
Reissue PoliciesGenetic Testing for Congenital Long QT Syndrome (Independence Administrators)06.02.31g1/1/20214/17/20244/17/2024
Coding UpdateTrigger Point Injections11.14.02r4/1/20244/1/2024
Coding UpdateSelf-Administered Drugs08.00.78aq4/1/20244/1/2024
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08p4/1/20244/1/2024
Coding UpdateReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.43f4/1/20244/1/2024
Coding UpdateEquipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes05.00.05r4/1/20244/1/2024
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring11.00.06t4/1/20244/1/2024
Coding UpdateWheelchair Options and Accessories05.00.67t4/1/20244/1/2024
Coding UpdateVedolizumab (Entyvio®) for Injection for Intravenous Use08.01.18h4/1/20244/1/2024
Coding UpdateNadofaragene Firadenovec-vncg (Adstiladrin®)08.02.11a4/1/20244/1/2024
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ak4/1/20244/1/2024
Coding UpdateTreatments for Complex Regional Pain Syndrome (CRPS)08.00.57r4/1/20244/1/2024
Coding UpdateElective Abortion11.06.02m4/1/20244/1/2024
Coding UpdateTocilizumab (Actemra®) for Intravenous Infusion08.00.85o4/1/20244/1/2024
Coding UpdateSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence11.17.04x4/1/20244/2/2024
Coding UpdateTreatment of Twin-Twin Transfusion Syndrome (TTTS)11.00.14g4/1/20244/2/2024
Coding UpdateBiofeedback Therapy07.00.01l4/1/20244/2/2024
Coding UpdateGenetic Testing (Independence Administrators)06.02.35am1/1/20244/3/2024
Coding UpdateModifier 50: Bilateral Procedure03.00.05x4/1/20244/5/2024
Coding UpdateModifier 62: Two Surgeons00.10.11y4/1/20244/5/2024
Coding UpdateModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS00.10.18w4/1/20244/5/2024
Coding UpdateComplementary and Integrative Health Services12.00.03h4/1/20244/8/2024
Coding UpdateLower Limb Prostheses05.00.59n4/1/20244/12/2024
Coding UpdatePrescription Digital Therapeutics and Mobile-Based Health Management Applications12.00.05b4/1/20244/12/2024
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21ad4/1/20244/12/2024
Coding UpdatePreventive Care Services00.06.02aq4/1/20244/19/2024