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News & AnnouncementsNutritional Counseling/Medical Nutrition Therapy for Independence Members9/11/2023
News & AnnouncementsCoverage of the COVID-19 Vaccination for Independence Commercial Members (Updated on September 22, 2023)9/22/2023
News & Announcements10/01/2023 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products9/28/2023
News & AnnouncementsCoverage of Respiratory Syncytial Virus Immunizations for Independence Commercial Members (Updated September 28, 2023)9/28/2023
NotificationsAbatacept (Orencia®) for Injection for Intravenous Use08.00.62o9/12/2023 11:00 AM12/11/20239/12/2023Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsNebulizers and Inhalation Solutions05.00.15t9/29/2023 11:00 AM1/1/20249/29/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
New PoliciesBeremagene Geperpavec (Vyjuvek™)08.02.109/11/20239/11/2023This is a New Policy.
Updated PoliciesDurvalumab (Imfinzi®) and tremelimumab-act (Imjudo®)08.01.65c9/4/20239/1/2023Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesHigh-Technology Radiology Services (Independence)09.00.46ao9/10/20239/11/2023General Description, Guidelines, or Informational Update
Updated PoliciesMusculoskeletal Services (Independence)00.01.66i9/10/20239/10/20239/11/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesSleep Disorder Testing and Positive Airway Pressure Therapy Services and Supplies07.03.05z9/10/20239/11/20239/11/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesPressure-Reducing Support Surfaces05.00.60j9/11/20239/11/2023Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and combination VEGF/Angiopoietin-2 (Ang-2) inhibitors08.00.74s6/20/2023 9:00 AM9/18/20239/18/2023Medical Necessity Criteria
Updated PoliciesCatheter Ablation of Cardiac Arrhythmias11.02.06p9/25/20239/25/2023Medical Necessity Criteria
Updated PoliciesKnee Orthoses05.00.47q9/25/20239/25/2023Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesReduction Mammoplasty11.08.02k9/25/20239/25/2023Medical Necessity Criteria
Updated PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01k9/25/20239/25/2023Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesObstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product00.03.10F9/25/20239/25/2023Coverage and/or Reimbursement Position
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bk9/25/20239/25/2023Coverage and/or Reimbursement Position
Updated PoliciesPalivizumab (Synagis)08.00.22q9/25/20239/25/2023General Description, Guidelines, or Informational Update
Updated PoliciesOutpatient Short-Term Rehabilitation Services Included in Capitation00.03.03i9/25/20239/25/2023Coverage and/or Reimbursement Position
Reissue PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids11.01.06g1/1/20239/6/20239/6/2023
Reissue PoliciesCranial Electrotherapy Stimulation05.00.80c1/1/20239/6/20239/6/2023
Reissue PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®)08.01.23i10/4/20219/6/20239/6/2023
Reissue PoliciesModifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)03.00.31g10/25/20219/6/20239/6/2023
Reissue PoliciesNational Correct Coding Initiative (NCCI) Code Pair Edits00.01.56b1/3/20229/6/20239/6/2023
Reissue PoliciesModifier 52: Reduced Services03.00.32b12/6/20219/6/20239/6/2023
Reissue PoliciesModifier 53: Discontinued Procedure03.00.33b12/6/20219/6/20239/6/2023
Reissue PoliciesTranscatheter Closure of Cardiac Septal Defects11.02.11h10/1/20229/6/20239/6/2023
Reissue PoliciesFirst-Trimester Prenatal Screening for Fetal Aneuploidy Using Fetal Ultrasound Markers09.00.36m11/21/20229/6/20239/6/2023
Reissue PoliciesHome Health Care Services02.01.01f8/29/20229/6/20239/6/2023
Reissue PoliciesPercutaneous Left Atrial Appendage Closure Devices for Stroke Prevention in Atrial Fibrillation11.02.26c7/18/20229/6/20239/6/2023
Reissue PoliciesTherapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)08.01.36e7/1/20209/6/20239/11/2023
Reissue PoliciesEtranacogene dezaparvovec-drlb (Hemgenix ®)08.02.035/22/20239/6/20239/11/2023
Reissue PoliciesBioimpedence for the Detection of Lymphedema07.06.03b12/29/20149/20/20239/20/2023
Reissue PoliciesRadioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)08.00.08j3/4/20199/20/20239/20/2023
Reissue PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74h12/5/20229/20/20239/20/2023
Reissue PoliciesEndovascular Stent-Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions11.02.17h10/1/20229/20/20239/20/2023
Coding UpdateGenetic Testing (Independence Administrators)06.02.35ak7/1/20239/18/2023
Coding UpdateRituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)08.00.50ab10/1/20239/29/2023
Coding UpdateAcupuncture12.00.01h10/1/20239/29/2023
Coding UpdateBiofeedback Therapy07.00.01k10/1/20239/29/2023
Coding UpdateTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74i10/1/20239/29/2023
Coding UpdateAmbulatory Blood Pressure Monitoring (ABPM) and Home Blood Pressure Monitoring (HBPM) Devices07.02.09i10/1/20239/29/2023
Coding UpdateElectroconvulsive Therapy (ECT)14.00.01a10/1/20239/29/2023
Coding UpdateNoninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (A​PAP) and Bi-Level Devices05.00.30p10/1/20239/29/2023
Coding UpdateAnesthesia Services for Epidural, Paravertebral Facet and Sacroiliac Joint Injections for Spinal Joint Management01.00.12b10/1/20239/29/2023
Coding UpdateHome-Based Sleep Studies07.03.01c10/1/20239/29/2023
Coding UpdateCranial Remolding Orthoses (Helmets)05.00.25j10/1/20239/29/2023
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21m10/1/20239/29/2023
Coding UpdateAutomatic External Cardioverter Defibrillators (Wearable and Nonwearable)05.00.29o10/1/20239/29/2023
Coding UpdateEsophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)07.02.22f10/1/20239/29/2023
Coding UpdateSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77d10/1/20239/29/2023
Coding UpdateTreatment of Obstructive Sleep Apnea (OSA) and Primary Snoring11.00.06q10/1/20239/29/2023
Coding UpdateCatheter Ablation of Cardiac Arrhythmias11.02.06q10/1/20239/29/2023
Coding UpdateWireless Capsule Endoscopy for Gastrointestinal (GI) Disorders07.05.02r10/1/20239/29/2023
Coding UpdateCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs10.01.01p10/1/20239/29/2023
Coding UpdateElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09u10/1/20239/29/2023
Coding UpdateNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18t10/1/20239/29/2023
Coding UpdateDeep Brain Stimulation (DBS)11.15.20s10/1/20239/29/2023
Coding UpdateTrilaciclib (Cosela™)08.01.77d10/1/20239/29/2023
Coding UpdateElectromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter07.03.21n10/1/20239/29/2023
Coding UpdateMentoplasty or Genioplasty11.14.01h10/1/20239/29/2023
Coding UpdateNeuropsychological Testing for Neurologically Based Conditions07.03.08n10/1/20239/29/2023
Coding UpdateVagus Nerve Stimulation (VNS)11.15.16t10/1/20239/29/2023
Coding Updatecrizanlizumab-tmca (Adakveo®)08.00.04a10/1/20239/29/2023
Coding UpdateImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)08.00.13ag10/1/20239/29/2023
Coding UpdateSelf-Administered Drugs08.00.78ao10/1/20239/29/2023
Coding UpdateNutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk08.00.18p10/1/20239/29/2023
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08n10/1/20239/29/2023
Coding UpdateIntravenous Chelation Therapy07.00.02j10/1/20239/29/2023
Coding UpdateWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ah10/1/20239/29/2023
Coding UpdateBortezomib (Bortezomib for Injection, Velcade®)08.00.73p10/1/20239/29/2023
Coding UpdateRepository Corticotropin Injection (Acthar® Gel, Purified Cortrophin[TM] Gel)08.01.12d10/1/20239/29/2023
Coding UpdateRetifanlimab-dlwr (Zynyz TM) 08.02.05a10/1/20239/29/2023
Coding UpdateDenosumab (Prolia®, Xgeva®), Romosozumab-aqqg (Evenity®)08.00.94q10/1/20239/29/2023
Coding UpdateBotulinum Toxin Agents08.00.26ab10/1/20239/29/2023
Coding UpdateEptinezumab-jjmr (VYEPTI™)08.00.45d10/1/20239/29/2023
Coding UpdateAbatacept (Orencia®) for Injection for Intravenous Use08.00.62o10/1/20239/29/2023
Coding UpdatePrescription Lenses and Visual Devices07.13.13f10/1/20239/29/2023
Coding UpdateTreatment of Medical and Surgical Complications11.00.02h10/1/20239/29/2023
Coding UpdateMohs Micrographic Surgery11.08.23k10/1/20239/29/2023