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News & AnnouncementsPharmaceutical Treatments of COVID-19 for Independence Commercial Members (Updated May 4, 2021)5/4/2021
NotificationsInebilizumab-cdon (Uplizna)08.01.68b5/11/2021 1:00 PM8/9/20215/11/2021Medical Necessity Criteria
New PoliciesMelphalan flufenamide (Pepaxto®)08.01.785/10/20215/10/2021This is a New Policy.
Updated PoliciesBotulinum Toxin Agents08.00.26x5/3/20215/3/2021Medical Necessity Criteria;Medical Coding
Updated PoliciesContrast Agents Used in Conjunction with Echocardiography09.00.11e4/2/2021 2:00 PM5/3/20215/3/2021General Description, Guidelines, or Informational Update
Updated PoliciesDenosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)08.00.94o5/10/20215/10/2021Medical Necessity Criteria
Updated PoliciesReimbursement for Associated Services Performed in Conjunction with Dental Care00.01.18e5/10/20215/10/2021General Description, Guidelines, or Informational Update
Reissue PoliciesHydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies08.01.00g10/1/20185/5/20215/5/2021
Reissue Policiescrizanlizumab-tmca (Adakveo®)08.00.0411/30/20205/5/20215/5/2021
Reissue PoliciesBelantamab mafodotin-blmf (Blenrep)08.01.70b4/1/20215/5/20215/5/2021
Reissue PoliciesAcupuncture (Independence)12.00.01f1/1/20195/7/20215/7/2021
Reissue PoliciesScreening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)09.00.40d2/18/20165/5/20215/7/2021
Reissue PoliciesPositron Emission Mammography (PEM)09.00.51a11/6/20135/5/20215/7/2021
Reissue PoliciesMoxetumomab Pasudotox-tdfk (Lumoxiti™)08.01.53b10/1/20195/5/20215/7/2021
Reissue PoliciesCerliponase alfa (Brineura®)08.01.39c6/3/20195/5/20215/10/20215/10/2021
Reissue PoliciesEmapalumab-lzsg (Gamifant®)08.01.54b10/1/20195/5/20215/10/20215/10/2021