| News & Announcements | Testing for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Commercial Members (Updated May 12, 2023) | | | | | | 5/12/2023 | | | |
| News & Announcements | Coverage of the COVID-19 Vaccination for Independence Commercial Members (Updated on May 12, 2023) | | | | | | 5/12/2023 | | | |
| News & Announcements | Pharmaceutical Prophylaxis and Treatments of COVID-19 for Independence Commercial Members (Updated May 12, 2023) | | | | | | 5/12/2023 | | | |
| Notifications | Luspatercept–aamt (Reblozyl®) | 08.00.10c | 5/22/2023 12:00 PM | 8/21/2023 | | | 5/22/2023 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Notifications | Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products | 00.03.07ak | 4/21/2023 2:00 PM | 7/31/2023 | | | 5/25/2023 | Coverage and/or Reimbursement Position | 5/25/2023 | |
| New Policies | Etranacogene dezaparvovec-drlb (Hemgenix ®) | 08.02.03 | | 5/22/2023 | | | 5/22/2023 | This is a New Policy. | | |
| New Policies | Elivaldogene Autotemcel [eli-cel (Skysona®)] | 08.01.92 | | 5/22/2023 | | | 5/22/2023 | This is a New Policy. | | |
| Updated Policies | Therapeutic Shoes and Orthopedic Shoes | 05.00.11k | | 5/8/2023 | | | 5/8/2023 | Coverage and/or Reimbursement Position;Medical Necessity Criteria | | |
| Updated Policies | Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP) | 07.02.22e | | 5/8/2023 | | | 5/8/2023 | General Description, Guidelines, or Informational Update | | |
| Updated Policies | Canakinumab (Ilaris®) | 08.01.51b | | 5/8/2023 | | | 5/8/2023 | Medical Coding | | |
| Updated Policies | Lurbinectedin (Zepzelca®) | 08.01.67c | | 5/8/2023 | | | 5/8/2023 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Tisotumab vedotin-tftv (Tivdak™) | 08.01.83b | | 5/8/2023 | | | 5/8/2023 | Medical Necessity Criteria | | |
| Updated Policies | Gender Affirming Interventions | 11.09.02n | | 5/8/2023 | | | 5/8/2023 | Coverage and/or Reimbursement Position;Medical Coding | | |
| Updated Policies | Patient Lifts | 05.00.42i | | 5/22/2023 | | | 5/22/2023 | Medical Necessity Criteria | | |
| Updated Policies | Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use | 08.00.66u | | 5/22/2023 | | | 5/22/2023 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Fam-trastuzumab deruxtecan-nxki (Enhertu®) | 08.00.12e | | 5/22/2023 | | | 5/22/2023 | Medical Necessity Criteria;Medical Coding | | |
| Updated Policies | Ultraviolet Light Therapy for the Treatment of Dermatological Conditions | 07.07.02m | | 5/22/2023 | | | 5/22/2023 | Medical Coding | | |
| Updated Policies | Ventricular Assist Devices (VADs) | 11.02.16u | 2/28/2023 11:00 AM | 5/29/2023 | | | 5/29/2023 | Medical Necessity Criteria;General Description, Guidelines, or Informational Update | | |
| Reissue Policies | Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Independence Administrators) | 11.15.23k | | 4/11/2022 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Labiaplasty | 11.06.09d | | 5/14/2018 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Panniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin | 11.08.06j | | 10/1/2018 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty | 11.08.13g | | 5/19/2017 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Orthognathic Surgery | 11.14.08d | | 6/30/2017 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Nucleoplasty | 11.15.19e | | 5/7/2014 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Migraine Deactivation Surgery | 11.15.24a | | 3/11/2015 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Mentoplasty or Genioplasty | 11.14.01g | | 6/25/2017 | | | 5/3/2023 | | | |
| Reissue Policies | Sutimlimab-jome (Enjaymo) | 08.01.87a | | 10/1/2022 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Autonomic Nervous System Testing | 07.03.23f | | 10/1/2022 | | | 5/3/2023 | | | |
| Reissue Policies | Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence | 11.17.04v | | 4/1/2023 | | | 5/3/2023 | | | |
| Reissue Policies | Vectra® DA Blood Test for Rheumatoid Arthritis | 06.02.45 | | 2/1/2016 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Teclistamab-cqyv (Tecvayli™) | 08.01.98a | | 4/1/2023 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Cerliponase alfa (Brineura®) | 08.01.39c | | 6/3/2019 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Pharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators) | 06.02.18m | | 1/1/2023 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36c | | 6/17/2019 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Topical Oxygenation | 07.00.09d | | 4/8/2015 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Pharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators) | 06.02.30f | | 1/1/2023 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ) | 08.00.72k | | 4/1/2022 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Burosumab-twza (Crysvita®) | 08.01.49b | | 3/15/2021 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Molecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators) | 06.02.36d | | 6/17/2019 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Noninvasive Prenatal Screening for Fetal Aneuploidies Using Cell-Free Fetal DNA (Independence Administrators) | 06.02.47e | | 10/1/2021 | 5/3/2023 | | 5/3/2023 | | | |
| Reissue Policies | Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA) | 09.00.40d | | 2/18/2016 | 5/3/2023 | | 5/4/2023 | | | |
| Reissue Policies | Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures | 05.00.70c | | 4/11/2022 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Day Rehabilitation | 10.00.02c | | 1/13/2020 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Pulmonary Rehabilitation | 10.04.01m | | 1/1/2022 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD) | 05.00.69c | | 1/1/2023 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Wireless Capsule Endoscopy for Gastrointestinal (GI) Disorders | 07.05.02q | | 1/1/2023 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Standing Frames | 05.00.71c | | 3/22/2017 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Trilaciclib (Cosela™) | 08.01.77c | | 6/20/2022 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Anesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management | 01.00.12a | | 10/1/2022 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi™) | 08.01.26d | | 8/30/2021 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Acupuncture | 12.00.01g | | 10/1/2021 | 5/17/2023 | | 5/17/2023 | | | |
| Reissue Policies | Steroid-Eluting Sinus Stents and Implants | 11.16.08f | | 9/13/2021 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Electron Beam Computed Tomography (EBCT) for Screening Evaluations | 09.00.02f | | 8/2/2021 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Measurement of Serum Antibodies to and Measurement of Serum Levels of Biologics | 06.02.39d | | 1/1/2020 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Measurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders | 07.11.02f | | 3/26/2018 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Proteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™) | 06.02.43b | | 2/1/2017 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Surgical Treatments of Athletic Pubalgia | 11.14.26a | | 6/3/2015 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Genetic Testing (Independence Administrators) | 06.02.35aj | | 4/1/2023 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | GIVOSIRAN (GIVLAARI®) | 08.00.21 | | 5/2/2022 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Emapalumab-lzsg (Gamifant®) | 08.01.54b | | 10/1/2019 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease | 06.02.56g | | 10/1/2022 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Evaluation and Treatment of Erectile Dysfunction (ED) | 11.11.01j | | 9/13/2021 | 5/31/2023 | | 5/31/2023 | | | |
| Reissue Policies | Moxetumomab Pasudotox-tdfk (Lumoxiti™) | 08.01.53b | | 10/1/2019 | 5/31/2023 | | 5/31/2023 | | | |
| Archived Policies | Belantamab mafodotin-blmf (Blenrep) | 08.01.70b | 5/31/2023 10:00 AM | 6/30/2023 | | | 5/31/2023 | | | |
| Archived Policies | Hydroxyprogesterone Caproate Injection as a Technique to Reduce the Risk of Preterm Birth in High-Risk Pregnancies | 08.01.00g | 5/31/2023 10:00 AM | 6/30/2023 | | | 5/31/2023 | | | |
| Archived Policies | GPS Cancer™ Testing by NantHealth | 06.02.50 | 5/31/2023 1:00 PM | 7/1/2023 | | | 5/31/2023 | | | |
