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News & AnnouncementsUpdate to the Preventive Coverage of Medicare Diabetes Prevention Program5/28/2024Update to the Preventive Coverage of Medicare Diabetes Prevention Program
NotificationsEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous  administrationMA08.044i5/21/2024 10:00 AM8/19/20245/21/2024Medical Necessity CriteriaEculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous  administration
NotificationsMultiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy ServicesMA00.050b5/31/2024 2:00 PM7/1/20245/31/2024Coverage and/or Reimbursement PositionMultiple Procedure Payment Reduction Guidelines for Physical, Occupational, and Speech Therapy Services
New PoliciesAuricular ProsthesesMA05.0685/20/20245/20/2024This is a New Policy.Auricular Prostheses
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ao4/1/20244/1/20245/1/2024Medical Necessity CriteriaPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services5/1/2024
Updated PoliciesPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMA00.010ao4/1/20244/1/20245/3/2024Medical Necessity CriteriaPPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Updated PoliciesImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)MA08.009u5/6/20245/6/2024Medical Necessity Criteria;Medical CodingImmune Globulin Intravenous (IVIG), Subcutaneous (SCIG)
Updated PoliciesBotulinum Toxin AgentsMA08.017k5/6/20245/6/2024Medical Necessity CriteriaBotulinum Toxin Agents
Updated PoliciesTracheostomy Care SuppliesMA05.034a4/6/2024 11:00 AM5/6/20245/6/2024Coverage and/or Reimbursement Position;General Description, Guidelines, or Informational UpdateTracheostomy Care Supplies
Updated PoliciesExperimental/Investigational ServicesMA00.005ak4/1/20245/6/2024Medical CodingExperimental/Investigational Services
Updated PoliciesDurvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)MA08.123d5/6/20245/6/2024Medical Necessity CriteriaDurvalumab (Imfinzi®) and Tremelimumab-actl (Imjudo®)
Updated PoliciesEnteral Nutritional TherapyMA08.003h5/6/20245/6/2024General Description, Guidelines, or Informational UpdateEnteral Nutritional Therapy
Updated PoliciesMogamulizumab-kpkc (Poteligeo®)MA08.102f5/20/20245/20/2024Medical Necessity CriteriaMogamulizumab-kpkc (Poteligeo®)
Updated PoliciesExternal Breast ProsthesesMA05.033c5/20/20245/20/2024Coverage and/or Reimbursement Position;Medical Necessity CriteriaExternal Breast Prostheses
Updated PoliciesAmivantamab-vmjw (Rybrevant®)MA08.148a5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateAmivantamab-vmjw (Rybrevant®)
Updated PoliciesMirvetuximab soravtansine-gynx (Elahere™)MA08.159b5/20/20245/20/2024Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateMirvetuximab soravtansine-gynx (Elahere™)
Updated PoliciesEvinacumab-dgnb (Evkeeza®) MA08.133c4/24/2024 10:00 AM5/27/20245/28/2024Coverage and/or Reimbursement Position;Medical Necessity Criteria;General Description, Guidelines, or Informational UpdateEvinacumab-dgnb (Evkeeza®)
Reissue PoliciesReimbursement for Components of Comprehensive Laboratory PanelsMA01.006a1/1/20245/1/20245/1/2024Reimbursement for Components of Comprehensive Laboratory Panels
Reissue PoliciesLumbar Interspinous Process Decompression SystemMA11.048c1/1/20245/1/20245/1/2024Lumbar Interspinous Process Decompression System
Reissue PoliciesHigh-Frequency Chest Wall Oscillation DevicesMA05.001i1/1/20245/1/20245/1/2024High-Frequency Chest Wall Oscillation Devices
Reissue PoliciesSeat Lift MechanismsMA05.011b1/1/20245/1/20245/1/2024Seat Lift Mechanisms
Reissue PoliciesAlpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)MA08.050b1/1/20245/1/20245/1/2024Alpha 1-Antitrypsin Therapy (e.g., Prolastin-C, Aralast NP, Glassia, Zemaira)
Reissue PoliciesExon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)) – Casimersen (Amondys 45)MA08.084c1/1/20245/1/20245/1/2024Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)) – Casimersen (Amondys 45)
Reissue PoliciesVagus Nerve Stimulation (VNS)MA11.019k1/2/20245/1/20245/1/2024Vagus Nerve Stimulation (VNS)
Reissue PoliciesDermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and SeptorhinoplastyMA11.099d9/25/20235/1/20245/1/2024Dermabrasion for Rhinophyma, Septoplasty, Rhinoplasty, and Septorhinoplasty
Reissue PoliciesDebridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe NailsMA11.014g10/1/20215/1/20245/1/2024Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Toe Nails
Reissue PoliciesElectroconvulsive Therapy (ECT)MA14.001a1/1/20245/1/20245/1/2024Electroconvulsive Therapy (ECT)
Reissue PoliciesAllergy ImmunotherapyMA07.055d1/1/20245/1/20245/1/2024Allergy Immunotherapy
Reissue PoliciesBurosumab-twza (Crysvita®)MA08.099b1/1/20245/1/20245/1/2024Burosumab-twza (Crysvita®)
Reissue PoliciesPatient Lifts MA05.031c1/1/20245/1/20245/1/2024Patient Lifts
Reissue PoliciesIntravenous Chelation TherapyMA07.016c1/1/20245/1/20245/1/2024Intravenous Chelation Therapy
Reissue PoliciesVentricular Assist Devices (VADs)MA11.011g1/1/20245/1/20245/1/2024Ventricular Assist Devices (VADs)
Reissue PoliciesDeep Brain Stimulation (DBS)MA11.005h1/2/20245/1/20245/1/2024Deep Brain Stimulation (DBS)
Reissue PoliciesEvaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)MA07.015a6/28/20175/1/20245/1/2024Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)
Reissue PoliciesScreening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)MA09.013b1/1/20245/1/20245/1/2024Screening for Vertebral Fracture with Dual-Energy X-ray Absorptiometry (DEXA/DXA)
Reissue PoliciesInstrument-Based Vision ScreeningMA07.048a1/1/20165/15/20245/15/2024Instrument-Based Vision Screening
Reissue PoliciesComplementary and Integrative Health ServicesMA12.001e4/1/20245/15/20245/15/2024Complementary and Integrative Health Services
Reissue PoliciesHigh Osmolar Contrast AgentsMA09.005a12/30/20155/15/20245/15/2024High Osmolar Contrast Agents
Reissue PoliciesBronchial ValvesMA11.0201/1/20245/15/20245/15/2024Bronchial Valves
Reissue PoliciesVoretigene Neparvovec-rzyl (Luxturna®) MA08.094c1/1/20245/15/20245/15/2024Voretigene Neparvovec-rzyl (Luxturna®)
Reissue PoliciesBelimumab (Benlysta®) for Intravenous UseMA08.057d1/1/20245/15/20245/15/2024Belimumab (Benlysta®) for Intravenous Use
Reissue PoliciesPositron Emission Mammography (PEM)MA09.0151/1/20245/15/20245/15/2024Positron Emission Mammography (PEM)
Reissue PoliciesPsychological TestingMA14.0021/1/20235/15/20245/15/2024Psychological Testing
Reissue PoliciesConsultation ServicesMA00.049b1/1/20235/15/20245/15/2024Consultation Services
Reissue PoliciesPercutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)MA05.064a1/1/20245/29/20245/29/2024Percutaneous Electrical Nerve Stimulation (PENS) and Percutaneous Neuromodulation Therapy (PNT)
Reissue PoliciesNucleoplastyMA11.1011/1/20155/29/20245/29/2024Nucleoplasty
Reissue PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)MA05.058d1/1/20245/29/20245/29/2024Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)MA08.053b1/1/20245/29/20245/29/2024Personalized Vaccines (e.g., Provenge®)
Reissue PoliciesAqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of GlaucomaMA11.105j1/1/20235/29/20245/29/2024Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
Reissue PoliciesTranscutaneous Electrical Nerve Stimulators (TENS) and Associated SuppliesMA05.006i1/1/20245/29/20245/29/2024Transcutaneous Electrical Nerve Stimulators (TENS) and Associated Supplies
Reissue PoliciesMechanical Stretching Devices for the Treatment of Joint Stiffness or ContracturesMA05.043b1/1/20245/29/20245/29/2024Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Reissue PoliciesEvaluation and Treatment of Erectile Dysfunction (ED)MA11.079e1/2/20245/29/20245/29/2024Evaluation and Treatment of Erectile Dysfunction (ED)
Reissue Policiescrizanlizumab-tmca (Adakveo®) MA08.109b1/1/20245/29/20245/29/2024crizanlizumab-tmca (Adakveo®)
Reissue PoliciesRemoval of Breast ImplantsMA11.076g6/5/20235/29/20245/29/2024Removal of Breast Implants
Reissue PoliciesRozanolixizumab-noli (Rystiggo)MA08.164a1/1/20245/29/20245/29/2024Rozanolixizumab-noli (Rystiggo)
Reissue PoliciesMeasurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab MA06.019c1/1/20245/29/20245/29/2024Measurement of Serum Antibodies to and Measurement of Serum Levels of Infliximab and Adalimumab
Reissue PoliciesGivosiran (Givlaari)MA08.1121/1/20245/29/20245/30/2024Givosiran (Givlaari)
Coding UpdateAbortionMA11.010c4/1/20245/1/2024Abortion5/1/2024
Coding UpdateAbortionMA11.010c4/1/20245/2/2024Abortion
Coding UpdateDurable Medical Equipment (DME)MA05.044q4/1/20245/3/2024Durable Medical Equipment (DME)5/3/2024
Coding UpdateDurable Medical Equipment (DME)MA05.044q4/1/20245/6/2024Durable Medical Equipment (DME)
Coding UpdateeviCore Lab ManagementMA06.034m4/1/20245/7/2024eviCore Lab Management
Coding UpdateLaboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) ProductsMA00.030af4/1/20245/17/2024Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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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.