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News & AnnouncementsTesting for SARS-CoV-2 (Coronavirus Disease 2019 (COVID-19)) for Independence Commercial Members (Updated December 15, 2022)12/15/2022
News & Announcements01/01/2023 CPT and HCPCS Quarterly Update Coverage Determinations for Commercial Products12/30/2022
NotificationsNoninvasive Respiratory Assist Devices (RADs): Continuous Positive Airway Pressure (CPAP) Devices, Auto-Adjusting Positive Airway Pressure (A​PAP) and Bi-Level Devices05.00.30n12/2/2022 9:00 AM1/2/202312/2/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationseviCore Lab Management (Independence)06.02.52aa12/2/2022 11:00 AM1/1/202312/2/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
NotificationsNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)05.00.73f12/2/2022 1:00 PM1/2/202312/2/2022Coverage and/or Reimbursement Position;Medical Coding
NotificationsInsertion of Implantable Infusion Pumps11.15.03l12/16/2022 9:00 AM1/16/202312/16/2022Medical Coding;General Description, Guidelines, or Informational Update
New PoliciesRapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders06.02.461/1/202312/15/2022This is a New Policy.
New PoliciesSpesolimab--sbzo (Spevigo®)08.01.9712/19/202212/19/2022This is a New Policy.
New PoliciesPsychological Testing14.00.0211/1/2022 10:00 AM1/1/202312/30/2022This is a New Policy.
New PoliciesApplied Behavior Analysis (ABA) for the Treatment of Autism Spectrum Disorders (ASD)14.00.0311/1/2022 10:00 AM1/1/202312/30/2022This is a New Policy.
New PoliciesBetibeglogene Autotemcel [Beti-Cel (ZYNTEGLO®)]08.01.891/1/202312/30/2022This is a New Policy.
New PoliciesElectroconvulsive Therapy (ECT)14.00.0111/1/2022 12:00 PM1/1/202312/30/2022This is a New Policy.
Updated PoliciesOstomy Supplies05.00.50n11/4/2022 9:00 AM12/5/202212/5/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesIn Vivo Allergy Sensitivity Testing07.00.05i12/5/202212/5/2022Medical Necessity Criteria
Updated PoliciesMusculoskeletal Services (Independence)00.01.66g11/6/202212/5/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria
Updated PoliciesInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79g12/5/202212/5/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesEquipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes05.00.05o12/5/202212/5/2022Coverage and/or Reimbursement Position
Updated PoliciesHigh-Technology Radiology Services (Independence)09.00.46am11/6/202212/5/2022General Description, Guidelines, or Informational Update
Updated PoliciesPercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)11.02.27f11/6/202212/5/2022General Description, Guidelines, or Informational Update
Updated PoliciesX-rays Associated with Fractures in the Office Setting00.03.09f12/5/202212/5/2022Coverage and/or Reimbursement Position
Updated PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies05.00.74h12/5/202212/5/2022Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services00.01.25bi12/5/202212/5/2022Coverage and/or Reimbursement Position
Updated PoliciesNever Events and Preventable Serious Adverse Events00.01.44j12/5/202212/5/2022General Description, Guidelines, or Informational Update
Updated PoliciesEflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related biosimilars08.01.32i11/18/2022 9:00 AM12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesIn Vitro Allergy Testing06.02.26e11/18/2022 10:00 AM12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesSpeech and Non-Speech Generating Devices05.00.32k12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21j12/19/202212/19/2022General Description, Guidelines, or Informational Update
Updated PoliciesTafasitamab-cxix (Monjuvi®) 08.01.81a12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesAdo-Trastuzumab Emtansine (Kadcyla®)08.01.11h12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesReduction Mammoplasty11.08.02j12/19/202212/19/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesScar Revision11.08.25n12/19/202212/19/2022Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational Update
Updated PoliciesReimbursement for Radiopharmaceutical Agents for Professional Providers09.00.32ac12/19/202212/19/2022Medical Coding
Updated PoliciesLoncastuximab tesirine-lpyl (Zynlonta®)08.00.59b12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesPolatuzumab vedotin-piiq (Polivy®)08.01.59d12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesCemiplimab-rwlc (Libtayo®)08.01.66b12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesEnfortumab vedotin-ejfv (Padcev®)08.00.43d12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesAvelumab (Bavencio®)08.01.64b12/19/202212/19/2022Medical Necessity Criteria
Updated PoliciesChemical Peels11.08.08h9/26/2022 2:00 PM12/26/202212/26/2022Coverage and/or Reimbursement Position
Updated PoliciesIntravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists and Related Biosimilars08.00.74q1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesGonadotropin-Releasing Hormone Agonist (Camcevi™, Eligard®, Fensolvi®, Lupron Depot®)08.01.33h1/2/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesMedical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)07.03.03h11/1/2022 10:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesTranscranial Magnetic Stimulation (TMS)07.03.22e11/1/2022 10:00 AM1/1/202312/30/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesMaintenance Treatment of Opioid or Alcohol Use Disorder 08.01.37b11/1/2022 9:00 AM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding
Updated PoliciesHome-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)05.00.69c11/1/2022 10:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesRoutine/Non-routine Vaccines08.01.04ab1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesEvaluation and Management of Autism Spectrum Disorder (ASD)07.03.07y11/1/2022 10:00 AM1/1/202312/30/2022Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesDurvalumab (Imfinzi®)08.01.65b1/2/202312/30/2022Coverage and/or Reimbursement Position
Updated PoliciesIntravenous Infliximab and Related Biosimilars08.00.34s1/2/202312/30/2022Medical Necessity Criteria;Medical Coding
Updated PoliciesCranial Electrotherapy Stimulation05.00.80c11/1/2022 10:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesAcute Care Facility Inpatient Transfers12.04.04b11/1/2022 11:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesWireless Capsule Endoscopy for Gastrointestinal (GI) Disorders07.05.02q1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesPertuzumab (Perjeta®)08.01.07i1/2/202312/30/2022Medical Necessity Criteria
Updated PolicieseviCore Lab Management (Independence)06.02.52aa12/2/2022 11:00 AM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesVagus Nerve Stimulation (VNS)11.15.16r11/1/2022 12:00 PM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update12/30/2022
Updated PoliciesDeep Brain Stimulation (DBS)11.15.20q11/1/2022 12:00 PM1/1/202312/30/2022Coverage and/or Reimbursement Position;Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesProcedures for the Treatment of Gastroesophageal Reflux Disease (GERD)11.03.11q1/2/202312/30/2022Medical Necessity Criteria;General Description, Guidelines, or Informational Update
Updated PoliciesWound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds11.08.20ae1/1/202312/30/2022Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational Update
Updated PoliciesTelemedicine Services00.10.41k11/1/2022 2:00 PM1/1/202312/30/2022Medical Necessity Criteria;Medical Coding12/30/2022
Updated PoliciesPresumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments06.02.44p11/1/2022 2:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesTherapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics06.02.55a11/1/2022 2:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesPharmacogenetic Testing to Determine Drug Sensitivity (Independence Administrators)06.02.30f11/1/2022 2:00 PM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesIntravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)08.01.80a11/1/2022 9:00 AM1/1/202312/30/2022General Description, Guidelines, or Informational Update
Updated PoliciesFetal Surgery11.00.03l1/2/202312/30/2022Medical Necessity Criteria
Updated PoliciesCetuximab (Erbitux®)08.00.67n1/2/202312/30/2022Medical Necessity Criteria
Coding UpdateGenetic Testing (Independence Administrators)06.02.35ah10/1/202212/7/2022
Coding UpdateSelf-Administered Drugs08.00.78al1/1/202312/30/2022
Coding UpdateCoverage of Anticancer Prescription Oral and Injectable Drugs and Biologics and Supportive Agents08.01.08k1/1/202312/30/2022
Coding UpdateAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring07.02.21k1/1/202312/30/2022
Coding UpdateBone Mineral Density (BMD) Testing09.00.04m1/1/202312/30/2022
Coding UpdateEquipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes05.00.05p1/1/202312/30/2022
Coding UpdateInsulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems05.00.79h1/1/202312/30/2022
Coding UpdateEsophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)07.02.22d1/1/202312/30/2022
Coding UpdateArtificial Intervertebral Lumbar Disc Insertion11.15.31b1/1/202312/30/2022
Coding UpdatePercutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound (Independence)11.02.27g1/1/202312/30/2022
Coding UpdatePercutaneous Vertebroplasty, Kyphoplasty and Sacroplasty (Independence Administrators)11.14.10t1/1/202312/30/2022
Coding UpdateAprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)08.01.41e1/1/202312/30/2022
Coding UpdateAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma11.05.16l1/1/202312/30/2022
Coding UpdateDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty11.16.01j1/1/202312/30/2022
Coding UpdateFecal Microbiota Transplantation (FMT)07.05.08c1/1/202312/30/2022
Coding UpdateOrthoptic/Pleoptic Training07.13.01j1/1/202312/30/2022
Coding UpdateBevacizumab (Avastin®) and Related Biosimilars For Oncologic Use08.00.66s1/1/202312/30/2022
Coding UpdateDiagnostic Radiology Services Included in Capitation00.03.02ad1/1/202312/30/2022
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products00.03.07ai1/1/202312/30/2022
Coding UpdateRisankizumab-rzaa (Skyrizi®) for Intravenous Use 08.01.95a1/1/202312/30/2022
Coding UpdateBortezomib (Bortezomib for Injection, Velcade®)08.00.73o1/1/202312/30/2022