Commercial
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News & AnnouncementsCoverage of the COVID-19 Vaccination for Independence Members12/11/2020
News & AnnouncementsVeklury® (remdesivir) (including in combination with Olumiant® (baricitinib)), Bamlanivimab® (LY-CoV555), and Casirivimab/Imdevimab for COVID-19 Treatment of Independence Commercial Members (Updated December 30, 2020)12/30/2020
NotificationseviCore Lab Management (Independence)06.02.52s12/1/2020 2:00 PM1/1/202112/1/2020Medical Necessity Criteria12/28/2020
NotificationsTocilizumab (Actemra®) for Intravenous Infusion08.00.85k12/8/2020 1:00 PM3/8/202112/8/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsAbatacept (Orencia®) for Injection for Intravenous Use08.00.62l12/8/2020 1:00 PM3/8/202112/8/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria
NotificationsGonadotropin-Releasing Hormone Agonist (Eligard®, Fensolvi®, Lupron Depot®)08.01.33c12/8/2020 1:00 PM3/8/202112/8/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsPercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)11.02.27d12/14/2020 2:00 PM3/14/202112/14/2020Medical Necessity Criteria;General Description, Guidelines, or Informational Update
NotificationsHigh-Technology Radiology Services (Independence) (AmeriHealth)09.00.46af12/14/2020 3:00 PM3/14/202112/14/2020General Description, Guidelines, or Informational Update
NotificationsSubcutaneous Implantable Cardioverter Defibrillator (S-ICD) for Treating Life-threatening Ventricular Tachyarrhythmia05.00.77b12/22/2020 11:00 AM3/22/202112/22/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsChimeric Antigen Receptor (CAR) Therapy08.01.43f12/24/2020 1:00 PM1/1/202112/24/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsModifiers for Assistant-at-Surgery Services: 80, 81, 82, and AS00.10.18m12/29/2020 2:00 PM3/29/202112/29/2020Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
NotificationsSeat Lift Mechanisms05.00.43g12/31/2020 8:00 AM2/8/202112/31/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
NotificationsFilgrastim  (Neupogen ®) and related biosimilars, and tbo-filgrastim (Granix ®)08.01.7312/31/2020 10:00 AM4/1/202112/31/2020This is a New Policy.
NotificationsTelemedicine Services (Independence)00.10.41h12/31/2020 1:00 PM4/1/202112/31/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsRepair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices05.00.44m12/31/2020 1:00 PM2/8/202112/31/2020Medical Coding
Notificationspegfilgrastim (Neulasta®) and related biosimilars08.01.32e12/31/2020 2:00 PM4/1/202112/31/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsDurable Medical Equipment (DME) and Consumable Medical Supplies05.00.21w12/31/2020 2:00 PM2/8/202112/31/2020Medical Coding
New PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso))08.01.341/1/202112/31/2020This is a New Policy.
Updated PoliciesImmune Prophylaxis for Respiratory Syncytial Virus (RSV)08.00.22n12/7/202012/7/2020Medical Necessity Criteria
Updated PoliciesBreast Pumps05.00.76d12/7/202012/7/2020General Description, Guidelines, or Informational Update
Updated PoliciesReimbursement for the Administration of Immunizations07.00.15m12/7/202012/7/2020General Description, Guidelines, or Informational Update
Updated PoliciesProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)11.03.11p12/7/202012/7/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20x12/21/202012/21/2020Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesModifier 50: Bilateral Procedure03.00.05n12/21/202012/21/2020General Description, Guidelines, or Informational Update
Updated PoliciesGolimumab (Simponi Aria®) Intravenous (IV) Injection08.01.15f12/21/202012/21/2020Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesModifier 62: Two Surgeons00.10.11n12/21/202012/21/2020General Description, Guidelines, or Informational Update
Updated PoliciesModifiers 26 (Professional Component) and TC (Technical Component)03.00.20k12/21/202012/21/2020General Description, Guidelines, or Informational Update
Updated PoliciesCast and Splint Applications and Associated Supplies00.10.15d12/21/202012/21/2020Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesNever Events and Preventable Serious Adverse Events00.01.44i12/21/202012/21/2020General Description, Guidelines, or Informational Update
Updated PoliciesRepair of Cleft Lip, Cleft Nose, and/or Cleft Palate11.03.01f12/21/202012/21/2020Medical Coding
Updated PoliciesPreventive Care Services00.06.02ae1/1/202112/28/2020Medical Necessity Criteria;Medical Coding
Updated PoliciesInterleukin-5 (IL-5) Antagonist (e.g., Cinqair®)08.01.23h1/1/202112/31/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesSelf-Administered Drugs08.00.78ag1/1/202112/31/2020Coverage and/or Reimbursement Position;Medical Coding
Updated PoliciesChimeric Antigen Receptor (CAR) Therapy08.01.43f12/24/2020 1:00 PM1/1/202112/31/2020Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Reissue PoliciesRefractive Keratoplasty11.05.01f7/1/201912/2/202012/2/2020
Reissue PoliciesBalloon Catheter Dilation of Sinus Ostia for Treatment of Chronic Rhinosinusitis11.16.06j1/1/202012/2/202012/2/2020
Reissue PoliciesSentinel Lymph Node Biopsy and Mapping11.07.02j5/31/201912/2/202012/2/2020
Reissue PoliciesIntravenous Chelation Therapy07.00.02i3/4/201912/2/202012/2/2020
Reissue PoliciesRadioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)08.00.08j3/4/201912/2/202012/2/2020
Reissue PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids11.01.06e6/17/201912/2/202012/2/2020
Reissue PoliciesSeptoplasty, Rhinoplasty, and Septorhinoplasty11.16.01h10/10/201712/3/202012/3/2020
Reissue PoliciesScanning Computerized Ophthalmic Diagnostic Imaging (SCODI)07.13.06l10/1/202012/3/202012/3/2020
Reissue PoliciesBlinatumomab (Blincyto®)08.01.21c10/8/201812/3/202012/3/2020
Reissue PoliciesTreatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents08.00.25m1/1/202012/3/202012/3/2020
Reissue PoliciesRadioembolization for Primary and Metastatic Tumors of the Liver09.00.48g12/2/201912/2/202012/3/2020
Reissue PoliciesAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21e1/1/202012/2/202012/4/2020
Reissue PoliciesScar Revision11.08.25m1/1/201812/2/202012/4/2020
Reissue PoliciesCardiac Rehabilitation (CR) and Intensive Cardiac Rehabilitation (ICR) Programs10.01.01n10/1/201712/2/202012/4/2020
Reissue PoliciesIntra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis11.14.07w7/1/202012/18/202012/18/2020
Reissue PoliciesSmell and Taste Dysfunction Testing07.11.01c5/7/201812/18/202012/18/2020
Reissue PoliciesElectromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)07.03.09q10/1/202012/18/202012/18/2020
Reissue PoliciesIntraoperative Neurophysiological Monitoring (INM)07.03.14o1/1/202012/18/202012/18/2020
Reissue PoliciesNerve Conduction Studies (NCS) and Related Electrodiagnostic Studies07.03.18p10/1/202012/18/202012/18/2020
Reissue PoliciesPhotodynamic Therapy (PDT) Using Levulan® Kerastick® or Ameluz® (Aminolevulinic Acid HCl [ALA])07.07.03m7/1/201912/16/202012/21/2020
Reissue PoliciesPhotocoagulation of Macular Drusen11.05.08d6/14/201712/16/202012/21/2020
Reissue PoliciesElectromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter07.03.21k10/1/201912/16/202012/21/2020
Reissue PoliciesRhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty11.08.13g5/19/201712/16/202012/21/2020
Reissue PoliciesMicroprocessor-Controlled Prostheses for Lower-Extremity Amputees11.14.21h12/9/201912/16/202012/21/2020
Reissue PoliciesWheelchair Cushions and Seating05.00.55i12/29/201712/16/202012/21/2020
Reissue PoliciesOrthognathic Surgery11.14.08d6/30/201712/16/202012/21/2020
Reissue PoliciesProcedures for the Treatment of Acne11.08.29e10/1/201612/16/202012/21/2020
Reissue PoliciesApheresis Therapy06.03.04n1/1/201812/21/202012/21/2020
Reissue PoliciesImmune Cell Function Assay06.02.37a11/6/20159/9/202012/22/2020
Reissue PoliciesProteomic (Protein)-Based Testing for the Evaluation of Ovarian (Adnexal) Masses Using OVA1® Test and Risk of Ovarian Malignancy Algorithm (ROMA™)06.02.43b2/1/201712/16/202012/23/2020
Reissue PoliciesMeasurement of Serum Antibodies to and Measurement of Serum Levels of Biologics06.02.39d1/1/202012/16/202012/23/2020
Reissue PoliciesIn Vitro Chemosensitivity and Chemoresistance Assays06.02.14i1/1/202012/16/202012/23/2020
Reissue PoliciesExtraction of Bony Impacted Teeth and Exposure of Impacted Teeth04.00.05d3/26/201412/16/202012/24/2020
Reissue PoliciesEsophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)07.02.22a10/1/202012/16/202012/24/2020
Reissue PoliciesPatisiran (Onpattro™)08.01.50b10/1/201912/16/202012/24/2020
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna™)08.01.44c1/1/201912/16/202012/24/2020
Reissue PoliciesMeasurement of Exhaled Nitric Oxide and Breath Condensate in the Diagnosis and Management of Asthma and Other Respiratory Disorders07.11.02f3/26/201812/16/202012/24/2020
Reissue PoliciesNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56c10/1/202012/28/2020
Reissue PoliciesMolecular Testing for the Management of Pancreatic Cysts or Barrett's Esophagus (Independence Administrators)06.02.36c6/17/201912/31/2020
Reissue PoliciesGenetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome) (Independence Administrators)06.02.10q10/1/201712/31/2020
Reissue PoliciesPharmacogenetics and Metabolite Monitoring for Using Azathioprine (AZA)/6-Mercaptopurine (6-MP) Therapy (Independence Administrators)06.02.18l4/1/202012/31/2020
Reissue PoliciesPharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators)06.02.30e7/1/201612/31/2020
Reissue PoliciesPreimplantation Genetic Testing (Independence Administrators)06.02.24j10/1/201612/31/2020
Reissue PoliciesMultigene Expression Assays for Predicting Recurrence in Colon Cancer (Independence Administrators)06.02.32d7/1/201612/31/2020
Reissue PoliciesGenetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)06.02.06q7/1/202012/31/2020
Coding UpdateServices Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers00.10.01ac12/14/202012/14/2020
Coding UpdateEsophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)07.02.22b10/1/202012/22/2020
Coding UpdateBariatric Surgery11.03.02t10/1/202012/22/2020
Coding UpdateCobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing06.02.54a10/1/202012/22/2020
Coding UpdateNoninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease06.02.56c10/1/202012/22/2020
Coding UpdateTesting Serum Vitamin D Levels06.02.51d10/1/202012/22/2020
Coding UpdateComputer-assisted Musculoskeletal Surgical Navigational Orthopedic Procedure11.14.17e1/1/202112/31/2020
Coding UpdateAssisted Reproductive Technology for Infertility and Oocyte Cryopreservation07.10.06i1/1/202112/31/2020
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21f1/1/202112/31/2020
Coding UpdateAllergy Immunotherapy07.00.21j1/1/202112/31/2020
Coding UpdateReduction Mammoplasty11.08.02i1/1/202112/31/2020
Coding UpdateLaboratory-Based Vestibular Function Testing07.03.24b1/1/202112/31/2020
Coding UpdateIntraoperative Neurophysiological Monitoring (INM)07.03.14p1/1/202112/31/2020
Coding UpdateRemoval of Breast Implants11.08.14l1/1/202112/31/2020
Coding UpdateIn Vivo Allergy Sensitivity Testing07.00.05h1/1/202112/31/2020
Coding UpdateCare Management and Care Planning Services00.01.59g1/1/202112/31/2020
Coding UpdateVentricular Assist Devices (VADs)11.02.16s1/1/202112/31/2020
Coding UpdateMagnetic Resonance Imaging (MRI)-Guided Focused Ultrasound Ablation11.06.06f1/1/202112/31/2020
Coding UpdateHigh-Technology Radiology Services (Independence)09.00.46ae1/1/202112/31/2020
Coding UpdateEvaluation and Management of Autism Spectrum Disorder (ASD)07.03.07u1/1/202112/31/2020
Coding UpdateReconstructive Breast Surgery11.08.15y1/1/202112/31/2020
Coding UpdateFrenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)11.03.05e1/1/202112/31/2020
Coding UpdateSurgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)11.17.06o1/1/202112/31/2020
Coding UpdateGenetic Testing (Independence Administrators)06.02.35aa1/1/202112/31/2020
Coding UpdatePresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44n1/1/202112/31/2020
Archived PoliciesSiltuximab (Sylvant®)08.01.19f12/2/2020 1:00 PM1/4/202112/2/2020
Archived PoliciesDeoxycholic Acid (Kybella™)08.01.24a12/2/2020 1:00 PM1/4/202112/2/2020
Archived PoliciesOfatumumab (Arzerra®)08.00.88f12/2/2020 1:00 PM1/4/202112/2/2020
Archived PoliciesEribulin Mesylate (Halaven®)08.00.98e12/2/2020 1:00 PM1/4/202112/2/2020
Archived PoliciesCabazitaxel (Jevtana®)08.00.96e12/2/2020 1:00 PM1/4/202112/2/2020
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Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.