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News & AnnouncementsPreventive Coverage of Colonoscopy Following a Positive Non-invasive Stool-based Screening Test or Direct Visualization Test for Independence Commercial Members6/14/2022
NotificationseviCore Lab Management (Independence)06.02.52y6/1/2022 3:00 PM7/1/20226/1/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsWheelchair Options and Accessories05.00.67r6/14/2022 9:00 AM7/18/20226/14/2022General Description, Guidelines, or Informational Update
NotificationsWheelchair Options and Accessories05.00.67r6/14/2022 12:00 PM7/18/20226/14/2022General Description, Guidelines, or Informational Update
NotificationsPower Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices05.00.54i6/17/2022 10:00 AM7/18/20226/17/2022General Description, Guidelines, or Informational Update
NotificationsAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16k6/20/2022 12:00 PM9/19/20226/20/2022Medical Coding
NotificationsCorneal Pachymetry Using Ultrasound07.13.07l6/20/2022 12:00 PM9/19/20226/20/2022Medical Coding
New PoliciesLaparoscopic, Percutaneous, and Transcervical Techniques for Uterine Fibroid Myolysis11.06.106/6/20226/6/2022This is a New Policy.
Updated PoliciesTelemedicine Services00.10.41j3/1/2022 9:00 AM6/1/20226/1/2022Medical Necessity Criteria6/1/20223/1/2022
Updated PoliciesCare Management and Care Planning Services00.01.59k5/30/20226/1/2022Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesTeprotumumab-trbw (Tepezza®)08.00.41a6/6/20226/6/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesAbatacept (Orencia®) for Injection for Intravenous Use08.00.62n6/6/20226/6/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesAssays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)06.02.27n6/6/20226/6/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesConsultation Services00.01.69a6/6/20226/6/2022General Description, Guidelines, or Informational Update
Updated PoliciesHigh-Technology Radiology Services09.00.46ak6/12/20226/13/2022General Description, Guidelines, or Informational Update
Updated PoliciesBrentuximab Vedotin (Adcetris®)08.01.13g6/20/20226/20/2022Medical Necessity Criteria
Updated PoliciesBlinatumomab (Blincyto®)08.01.21e6/20/20226/20/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesMargetuximab-cmkb (Margenza)08.01.75b6/20/20226/20/2022Medical Necessity Criteria
Updated PoliciesLanreotide (Somatuline® Depot)08.01.40d6/20/20226/20/2022Medical Necessity Criteria
Updated PoliciesRadiation Therapy Services (Independence)09.00.56n5/1/20226/20/2022Medical Necessity Criteria
Updated PoliciesTrilaciclib (Cosela™)08.01.77c6/20/20226/20/2022Medical Necessity Criteria
Reissue PoliciesAlemtuzumab (Lemtrada®)08.01.22d5/4/20206/1/20226/1/2022
Reissue PoliciesAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C®, Aralast NP®, Glassia®, Zemaira®)08.00.91e1/4/20216/1/20226/1/2022
Reissue PoliciesPertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)08.01.72a3/21/20226/1/20226/1/2022
Reissue PoliciesAnifrolumab-fnia (Saphnelo™)08.01.82b4/1/20226/1/20226/1/2022
Reissue PoliciesDofetilide (Tikosyn®) Use in the Inpatient Setting08.00.49e9/26/20196/1/20226/2/2022
Reissue PoliciesPersonalized Vaccines (e.g. Provenge®)08.00.95f12/20/20216/1/20226/2/2022
Reissue PoliciesNatalizumab (Tysabri®)08.00.64g10/21/20196/1/20226/2/2022
Reissue PoliciesEdaravone (Radicava®)08.01.42a12/23/20186/1/20226/3/2022
Reissue PoliciesGenetic Testing (Independence Administrators)06.02.35af4/1/20226/1/20226/6/2022
Reissue PoliciesGenetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)06.02.10r1/1/20216/1/20226/6/2022
Reissue PoliciesPreimplantation Genetic Testing (Independence Administrators)06.02.24j10/1/20166/1/20226/6/2022
Reissue PoliciesGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)06.02.06r10/1/20216/1/20226/6/2022
Reissue PoliciesGenetic Testing for Congenital Long QT Syndrome (Independence Administrators)06.02.31g1/1/20216/1/20226/6/2022
Reissue PoliciesAutonomic Nervous System Testing07.03.23e1/1/20226/15/20226/15/2022
Reissue PoliciesFecal Microbiota Transplantation (FMT)07.05.08b5/31/20216/15/20226/15/2022
Reissue PoliciesOrthoptic/Pleoptic Training07.13.01i1/1/20226/15/20226/15/2022
Reissue PoliciesPhotodynamic Therapy (PDT) Using Verteporfin (Visudyne®)07.13.05k5/7/20186/15/20226/15/2022
Reissue PoliciesPhotocoagulation of Macular Drusen11.05.08d6/14/20176/15/20226/15/2022
Reissue PoliciesPanniculectomy, Abdominoplasty, Abdominal Lipectomy, and Other Excisions of Redundant Skin11.08.06j10/1/20186/15/20226/15/2022
Reissue PoliciesParenterally Administered Terbutaline Sulfate for the Prevention or Treatment of Pre-Term Labor07.10.04c2/22/20176/15/20226/15/2022
Reissue PoliciesNoncontraceptive Use of the Levonorgestrel-Releasing Intrauterine System07.10.05m4/20/20206/15/20226/15/2022
Reissue PoliciesPositron Emission Mammography (PEM)09.00.51a11/6/20136/15/20226/15/2022
Reissue PoliciesSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77b3/22/20216/15/20226/15/2022
Reissue PoliciesTotal Artificial Hearts (TAHs)11.02.19f1/1/20196/15/20226/15/2022
Reissue PoliciesOcrelizumab (Ocrevus®)08.01.38c9/17/20196/15/20226/15/2022
Reissue PoliciesSpinal Decompression with Interspinous and Interlaminar Devices11.14.22d1/1/20176/15/20226/15/2022
Reissue PoliciesComputer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure11.14.17e1/1/20216/15/20226/16/2022
Reissue PoliciesPhotodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])07.07.03m7/1/20196/15/20226/16/2022
Reissue PoliciesPercutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis11.15.22d1/1/20176/15/20226/16/2022
Reissue PoliciesInstrument-Based Vision Screening07.13.12d1/1/20166/15/20226/16/2022
Reissue PoliciesPercutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)05.00.759/30/20146/15/20226/16/2022
Reissue PoliciesFoot Orthotics and Other Podiatric Appliances05.00.35f5/4/20206/15/20226/16/2022
Reissue PoliciesPercutaneous Discectomy11.15.15g12/1/20176/15/20226/16/2022
Reissue PoliciesCast and Splint Applications and Associated Supplies00.10.15d12/21/20206/15/20226/16/2022
Reissue PoliciesComplementary and Integrative Health Services12.00.03g5/25/20206/15/20226/16/2022
Reissue PoliciesReimbursement for an Intraocular Lens11.05.10c1/18/20216/15/20226/16/2022
Reissue PoliciesHair Transplants and Cranial Prostheses (Wigs)11.08.01g9/9/20196/15/20226/17/2022
Reissue PoliciesComplete Decongestive Therapy (CDT)07.06.01b12/30/20136/15/20226/17/2022
Reissue PoliciesBioimpedence for the Detection of Lymphedema07.06.03b12/29/20146/15/20226/17/2022
Reissue PoliciesEvaluation and Treatment of Erectile Dysfunction (ED)11.11.01j9/13/20216/15/20226/17/2022
Reissue PoliciesCryosurgical Ablation of the Prostate Gland11.11.03d4/6/20156/15/20226/17/2022
Reissue PoliciesTumor Treating Fields07.03.26a1/27/20206/15/20226/17/2022
Reissue PoliciesBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis11.16.06j1/1/20206/15/20226/17/2022