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News & Announcements04/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products4/1/2025
Updated PoliciesTelemedicine Services00.10.41o4/7/20254/7/2025Medical Coding
Reissue PoliciesSurgery for Gynecomastia11.08.12i1/1/20244/2/20254/2/2025
Reissue PoliciesPercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis11.15.22d1/1/20174/2/20254/2/2025
Reissue PoliciesBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis or Recurrent Acute Rhinosinusitis11.16.06k10/21/20244/2/20254/2/2025
Reissue PoliciesHome-Based Sleep Studies07.03.01d10/1/20244/2/20254/2/2025
Reissue PoliciesOsteochondral Allograft Transplantation (Independence Administrators)11.14.12f1/10/20214/2/20254/3/2025
Reissue PoliciesOsteochondral Autograft Transplantation (Independence Administrators)11.14.09h1/10/20214/2/20254/3/2025
Reissue PoliciesManual Wheelchairs05.00.12j4/13/20234/2/20254/4/2025
Reissue PoliciesSeat Lift Mechanisms05.00.43h4/13/20234/2/20254/4/2025
Reissue PoliciesPatient Lifts05.00.42i5/22/20234/2/20254/4/2025
Reissue PoliciesWheelchair Cushions and Seating05.00.55l8/14/20234/2/20254/4/2025
Reissue PoliciesWheelchair Options and Accessories05.00.67u4/1/20254/4/2025
Reissue PoliciesTranscatheter Cardiac Valve Procedures11.02.25j10/1/20244/2/20254/4/2025
Reissue PoliciesPercutaneous Transluminal Angioplasty (PTA) Concurrent with or without Stenting of the Extracranial Carotid Artery or Intracranial Artery11.02.12k4/8/20244/2/20254/4/2025
Reissue PoliciesExtraction of Bony Impacted Teeth and Exposure of Impacted Teeth04.00.05d3/26/20144/2/20254/4/2025
Reissue PoliciesPulse Oximetry Devices in the Home Setting05.00.31e5/7/20184/2/20254/4/2025
Reissue PoliciesDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toenails11.08.17k10/1/20214/2/20254/4/2025
Reissue PoliciesPercutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation11.02.26c7/18/20224/2/20254/4/2025
Reissue PoliciesPulmonary Rehabilitation10.04.01m1/1/20224/2/20254/4/2025
Reissue PoliciesAutomatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29o10/1/20234/2/20254/4/2025
Reissue PoliciesTeclistamab-cqyv (Tecvayli®)08.01.98c4/8/20244/2/20254/4/2025
Reissue PoliciesSteroid-Eluting Sinus Stents and Implants11.16.08f9/13/20214/2/20254/4/2025
Reissue PoliciesSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77e3/25/20244/2/20254/4/2025
Reissue PoliciesMedical Nutrition Therapy (MNT)/Nutrition Counseling10.00.041/1/20254/2/20254/4/2025
Reissue PoliciesNatalizumab (Tysabri®) and Related Biosimilars08.00.64h4/1/20244/2/20254/4/2025
Reissue PoliciesAlemtuzumab (Lemtrada®)08.01.22d5/4/20204/2/20254/4/2025
Reissue PoliciesFetal Fibronectin Enzyme (fFN) Immunoassay06.02.04d12/4/20154/2/20254/4/2025
Reissue PoliciesCryosurgical Ablation of the Prostate Gland11.11.03d4/6/20154/2/20254/4/2025
Reissue PoliciesOsteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)05.00.81a9/23/20244/2/20254/4/2025
Reissue PoliciesHome Oxygen Therapy05.00.58o7/17/20234/2/20254/4/2025
Reissue PoliciesUltraviolet Light Therapy for the Treatment of Dermatological Conditions07.07.02o10/1/20244/2/20254/4/2025
Reissue PoliciesSolid Organ Transplantation and Procurement Cost of Organs and Tissues11.00.09g6/17/20244/2/20254/4/2025
Reissue PoliciesCompression Garments05.00.37i1/1/20244/2/20254/4/2025
Reissue PoliciesHospital Beds and Accessories05.00.56l4/17/20234/2/20254/4/2025
Reissue PoliciesLower Limb Prostheses05.00.59p10/1/20244/2/20254/4/2025
Reissue PoliciesStanding Frames05.00.71c3/22/20174/2/20254/4/2025
Reissue PoliciesEnfortumab vedotin-ejfv (Padcev®)08.00.43f4/8/20244/2/20254/7/2025
Reissue PoliciesElranatamab-bcmm (Elrexfio™) 08.02.184/22/20244/2/20254/7/2025
Reissue PoliciesNegative Pressure Wound Therapy Systems05.00.38m1/22/20244/2/20254/7/2025
Reissue PoliciesModifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional03.00.02c6/21/20214/16/20254/16/2025
Reissue PoliciesModifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)03.00.31g10/25/20214/16/20254/16/2025
Reissue PoliciesAutologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)11.14.06j1/10/20214/16/20254/16/2025
Reissue PoliciesModifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional03.00.11c6/21/20214/16/20254/16/2025
Reissue PoliciesMeniscal Allograft Transplantation and Meniscal Implants (Independence Administrators)11.14.03h1/10/20214/16/20254/16/2025
Reissue PoliciesReimbursement for the Administration of Drugs, Substances, and/or Biologic Agents00.10.43f4/1/20244/16/20254/16/2025
Reissue PoliciesIntravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances00.01.451/8/20104/16/20254/16/2025
Reissue PoliciesRoutine Foot Care for Certain Medical Conditions07.07.01q10/1/20214/16/20254/16/2025
Coding UpdateNot Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests00.01.24l4/1/20254/1/2025
Coding UpdateHematopoietic Stem Cell Transplantation (Bone Marrow Transplant)11.07.01aa4/1/20254/1/2025
Coding UpdateReconstructive Breast Surgery and Post-Mastectomy Prostheses 11.08.15ac4/1/20254/1/2025
Coding UpdateAnkle-Foot/Knee-Ankle-Foot Orthoses05.00.39v4/1/20254/1/2025
Coding UpdateMechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures05.00.70e4/1/20254/1/2025
Coding UpdateUpper Limb Prostheses05.00.72h4/1/20254/1/2025
Coding UpdateMicroprocessor-Controlled Prostheses for Lower-Extremity Amputees11.14.21l4/1/20254/1/2025
Coding UpdateTrigger Point Injections11.14.02s4/1/20254/1/2025
Coding UpdateInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79l4/1/20254/1/2025
Coding UpdateFilgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)08.01.73h4/1/20254/1/2025
Coding UpdateWheelchair Options and Accessories05.00.67u4/1/20254/1/2025
Coding UpdatePreventive Care Services00.06.02au4/1/20254/1/2025
Coding UpdateWheelchair Cushions and Seating05.00.55l4/1/20254/1/2025
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ao4/1/20254/1/2025
Coding UpdateAtezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)08.01.69e4/1/20254/1/2025
Coding UpdateIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors08.00.74y4/1/20254/1/2025
Coding UpdateCoagulation Factors08.00.92ai4/1/20254/1/2025
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08t4/1/20254/1/2025
Coding UpdateEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris®) for intravenous administration08.00.84l4/1/2025
Coding UpdateGender-Affirming Interventions11.09.02q4/1/20254/1/2025
Coding UpdateDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21ag4/1/20254/1/2025
Coding UpdateModifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service03.00.06ac4/1/20254/1/2025
Coding UpdateReimbursement for Radiopharmaceutical Agents for Professional Providers09.00.32ai4/1/20254/1/2025
Coding UpdateRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices05.00.44s4/1/20254/4/2025
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products00.03.07ap4/1/20254/4/2025
Coding UpdateAfamitresgene autoleucel (Tecelra®)08.02.32a4/1/20254/14/2025
Coding UpdateCompression Garments05.00.37j4/1/20254/2/20254/14/2025
Coding UpdatePPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bs4/1/20254/15/2025