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News & AnnouncementsThe Aurora Extravascular Implantable Cardioverter Defibrillator (EV-ICD) System (Medtronic Inc.) for the treatment of life-threatening ventricular arrhythmias (Retroactively Effective To October 20, 2023)5/22/2025The Aurora Extravascular Implantable Cardioverter Defibrillator (EV-ICD) System (Medtronic Inc.) for the treatment of life-threatening ventricular arrhythmias (Retroactively Effective To October 20, 2023)
New PoliciesTango Home Health Care Services ManagementMA00.0545/1/20255/1/2025This is a New Policy.Tango Home Health Care Services Management
New PoliciesImetelstat (Rytelo™)MA08.1775/19/20255/19/2025This is a New Policy.Imetelstat (Rytelo™)
Updated PoliciesExperimental/Investigational ServicesMA00.005ao4/1/20255/5/2025Medical CodingExperimental/Investigational Services
Updated PoliciesWalkersMA05.037a4/12/2025 11:00 AM5/12/20255/12/2025Medical Necessity Criteria;Medical CodingWalkers
Updated PoliciesGivosiran (Givlaari) and Panhematin (Hemin)MA08.112a5/19/20255/19/2025Medical Necessity Criteria;Medical Coding;General Description, Guidelines, or Informational UpdateGivosiran (Givlaari) and Panhematin (Hemin)
Updated PoliciesAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) MonitoringMA07.026r1/1/20255/19/2025Medical Necessity Criteria;Medical CodingAmbulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Updated PoliciesTranscatheter Cardiac Valve ProceduresMA11.027f3/19/20255/19/2025Coverage and/or Reimbursement PositionTranscatheter Cardiac Valve Procedures
Updated PoliciesDostarlimab-gxly (Jemperli)MA08.136f5/19/20255/19/2025Medical Necessity CriteriaDostarlimab-gxly (Jemperli)
Updated PoliciesIntrauterine Systems (IUSs) (e.g., Mirena®, Skyla®, Liletta®, Kyleena®)MA07.025g12/28/20235/19/2025Medical Necessity CriteriaIntrauterine Systems (IUSs) (e.g., Mirena®, Skyla®, Liletta®, Kyleena®)
Reissue PoliciesMonoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's DiseaseMA08.151d7/2/20243/5/20255/23/2025Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer's Disease
Reissue PoliciesStem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic ConditionsMA07.008e1/6/20253/5/20255/23/2025Stem-Cell Therapy/Platelet-Rich Plasma for Orthopedic Applications and ​Platelet-Rich Plasma/Platelet-Derived Growth Factor for Wound Healing and Other Miscellaneous Non-Orthopedic Conditions
Reissue PoliciesEnzyme Replacement for the Treatment of Gaucher's DiseaseMA08.023c1/1/20245/28/20255/28/2025Enzyme Replacement for the Treatment of Gaucher's Disease
Reissue PoliciesRozanolixizumab-noli (Rystiggo)MA08.164a1/1/20245/28/20255/28/2025Rozanolixizumab-noli (Rystiggo)
Reissue PoliciesCrovalimab-akkz (PiaSky) MA08.1781/1/20255/28/20255/28/2025Crovalimab-akkz (PiaSky)
Reissue PoliciesVelmanase alfa (Lamzede)MA08.1473/11/20245/28/20255/28/2025Velmanase alfa (Lamzede)
Reissue PoliciesMargetuximab-cmkb (Margenza)MA08.132d11/18/20245/28/20255/28/2025Margetuximab-cmkb (Margenza)
Reissue PoliciesPersonalized Vaccines (e.g., Provenge®)MA08.053b1/1/20245/28/20255/28/2025Personalized Vaccines (e.g., Provenge®)
Reissue PoliciesReconstructive Breast SurgeryMA11.030h10/21/20245/28/20255/28/2025Reconstructive Breast Surgery
Reissue PoliciesSpeech TherapyMA10.007c1/1/20205/28/20255/28/2025Speech Therapy
Reissue PoliciesMigraine Deactivation SurgeryMA11.0981/1/20245/28/20255/28/2025Migraine Deactivation Surgery
Reissue PoliciesManipulation Under AnesthesiaMA11.091b1/1/20245/28/20255/28/2025Manipulation Under Anesthesia
Reissue PoliciesSacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of IncontinenceMA11.028k10/1/20245/28/20255/28/2025Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
Reissue PoliciesFecal Microbiota Transplantation (FMT)MA07.006d7/1/20235/28/20255/28/2025Fecal Microbiota Transplantation (FMT)
Reissue PoliciesSecukinumab (Cosentyx®) for Intravenous UseMA08.1747/1/20245/28/20255/28/2025Secukinumab (Cosentyx®) for Intravenous Use
Reissue PoliciesTeplizumab-mzwv (Tzield)MA08.157b11/11/20245/28/20255/28/2025Teplizumab-mzwv (Tzield)
Reissue PoliciesADAMTS13, recombinant-krhn (Adzynma)MA08.1717/15/20245/28/20255/28/2025ADAMTS13, recombinant-krhn (Adzynma)
Reissue PoliciesInjectable Dermal Fillers for Cosmetic ProceduresMA05.021b7/1/20235/28/20255/28/2025Injectable Dermal Fillers for Cosmetic Procedures
Reissue PoliciesMentoplasty or GenioplastyMA11.080b10/1/20235/28/20255/28/2025Mentoplasty or Genioplasty
Reissue PoliciesLurbinectedin (Zepzelca®)MA08.125c5/8/20235/28/20255/28/2025Lurbinectedin (Zepzelca®)
Reissue PoliciesIn Vitro Allergy TestingMA06.002c1/1/20245/28/20255/28/2025In Vitro Allergy Testing
Reissue PoliciesCanakinumab (Ilaris®)MA08.101c1/6/20255/28/20255/28/2025Canakinumab (Ilaris®)
Reissue PoliciesPozelimab-bbfg (Veopoz®)MA08.1674/1/20245/28/20255/28/2025Pozelimab-bbfg (Veopoz®)
Reissue PoliciesAnifrolumab-fnia (Saphnelo®)MA08.140c6/17/20245/28/20255/28/2025Anifrolumab-fnia (Saphnelo®)
Reissue PoliciesBone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing AidsMA11.049g4/22/20245/28/20255/28/2025Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Reissue PoliciesEptinezumab-jjmr (VYEPTI™)MA08.116d1/1/20245/28/20255/28/2025Eptinezumab-jjmr (VYEPTI™)
Reissue PoliciesBurosumab-twza (Crysvita®)MA08.099b1/1/20245/28/20255/28/2025Burosumab-twza (Crysvita®)
Reissue PoliciesSpesolimab-sbzo (Spevigo®)MA08.155b8/12/20245/28/20255/28/2025Spesolimab-sbzo (Spevigo®)
Reissue PoliciesOstomy Supplies MA05.014e1/1/20245/28/20255/28/2025Ostomy Supplies
Reissue PoliciesAgalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)MA08.033d9/9/20245/28/20255/28/2025Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)
Reissue PoliciesEndovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic AneurysmsMA11.012f1/1/20245/28/20255/28/2025Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Reissue PoliciesRhytidectomy and/or Cervicoplasty With or Without Liposuction and/or PlatysmaplastyMA11.075b1/1/20255/28/20255/28/2025Rhytidectomy and/or Cervicoplasty With or Without Liposuction and/or Platysmaplasty
Reissue PoliciesNeuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)MA05.058d1/1/20245/28/20255/28/2025Neuromuscular Electrical Stimulators (NMES) and Functional Electrical Stimulators (FES)
Reissue PoliciesCollagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)MA08.1281/1/20245/28/20255/28/2025Collagenase clostridium histolyticum ( Xiaflex ®), collagenase clostridium histolyticum-aaes (Qwo®)
Reissue PoliciesBelimumab (Benlysta®) for Intravenous UseMA08.057d1/1/20245/28/20255/28/2025Belimumab (Benlysta®) for Intravenous Use
Coding UpdateAlways Bundled Procedure CodesMA00.026w1/1/20255/1/2025Always Bundled Procedure Codes5/1/2025
Coding UpdateAlways Bundled Procedure CodesMA00.026w1/1/20255/12/2025Always Bundled Procedure Codes
Coding UpdateRemote Patient MonitoringMA12.010c1/1/20255/14/20255/14/2025Remote Patient Monitoring
Coding UpdateRapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic DisordersMA06.035a1/1/20245/16/2025Rapid Whole Exome Sequencing (rWES) and Rapid Whole Genome Sequencing (rWGS) for Diagnosis of Genetic Disorders
Coding UpdateeviCore Lab ManagementMA06.034q4/1/20255/23/2025eviCore Lab Management
Coding UpdatePreventive Care ServicesMA00.003ac4/1/20255/30/20255/30/2025Preventive Care Services
Archived PoliciesComplete Decongestive Therapy (CDT)MA07.0425/5/2025 9:00 AM6/9/20255/15/2025Complete Decongestive Therapy (CDT)
Archived PoliciesNational Correct Coding Initiative (NCCI) Code Pair EditsMA00.041a5/28/2025 1:00 PM6/30/20255/28/2025National Correct Coding Initiative (NCCI) Code Pair Edits
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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.