Click here to view the United Healthcare (UHC) Medical Policy Updates » November 2024 United…
Independence Blue Cross Medical Policy Updates – January 2019
Click here to view the Independence Blue Cross Medical Policy Updates »
January 2019 Medical Policy Updates:
- Acute Care Facility Inpatient Transfers
- Air Ambulance Services
- Allergy Immunotherapy
- Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
- Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
- Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis (Independence Administrators)
- Assisted Reproductive Technology for Infertility and Oocyte Cryopreservation
- Bevacizumab (Avastin®) and related biosimilars
- Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
- Bortezomib (Bortezomib for Injection, Velcade®)
- Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy (Independence Administrators)
- Burosumab-twza (Crysvita®)
- Care Management and Care Planning Services
- Cerliponase alfa (Brineura™)
- Chimeric Antigen Receptor (CAR) Therapy
- Coagulation Factors
- Colorectal Cancer Screening
- Complementary and Integrative Health Services
- Deep Brain Stimulation (DBS)
- Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum
- Edaravone (Radicava™)
- Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase™, Vimizim™, Naglazyme®, Mepsevii™, etc.)
- Evaluation and Management of Autism Spectrum Disorders (ASD)
- Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)
- eviCore Lab Management Program (Independence)
- Facility Reporting of Observation Services
- Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)
- Genetic Testing (Independence Administrators)
- Ground Ambulance Transport Services (Emergency and Nonemergency)
- High-Frequency Chest Wall Oscillation Devices
- Home Oxygen Therapy
- ibalizumab-uiyk (Trogarzo™)
- Immunizations
- Implantable Steroid-Eluting Sinus Stents
- Infliximab and Related Biosimilars
- Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)
- Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra™)
- Intra-Articular Injection of Hyaluronan for the Treatment of Osteoarthritis
- Mogamulizumab-kpkc (Poteligeo®)
- Moxetumomab Pasudotox-tdfk (Lumoxiti™)
- Multiple Procedure Payment Reduction (MPPR) on Certain Diagnostic Services
- Nerve Fiber Density Testing
- Neuropsychological Testing for Neurologically Based Conditions
- Noninvasive Techniques for the Evaluation and Monitoring of Individuals with Chronic Liver Disease
- Nutritional Formulas, Enteral Nutrition, Medical Foods, Low-Protein Modified Food Products, and Donated Breast Milk
- Paclitaxel Protein-bound Particles for Injectable Suspension (Albumin-bound) / (Abraxane® for Injectable Suspension)
- Patisiran (Onpattro™)
- Pegloticase (Krystexxa®)
- Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
- Preventive Care Services (Independence)
- Programmed Death Receptor-1 (PD-1) Antagonists (e.g., Keytruda®, Opdivo®) and Programmed Death-Ligand 1 (PD-L1) Antagonists (e.g., Tecentriq®, Bavencio®, Imfinzi™)
- Radiation Therapy Services (Independence)
- Radiologic Guidance of a Procedure
- Ramucirumab (Cyramza®)
- Reporting and Documentation Requirements for Anesthesia Services
- Rituximab (Rituxan®) infusion, and rituximab and hyaluronidase human (Rituxan Hycela™) for subcutaneous injection
- Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
- Self-Administered Drugs
- Sentinel Lymph Node Biopsy
- Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
- Telemedicine for Primary Care Services (Independence)
- Therapeutic Shoes and Orthopedic Shoes
- Tildrakizumab-asmn (Ilumya™)
- Total Artificial Hearts (TAHs)
- Treatment of Gender Dysphoria
- Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring for Adults
- Treatment of Varicose Veins of the Lower Extremities and Perforator Vein Incompetence
- Triamcinolone Acetonide Extended-Release Injectable (Zilretta™)
- Voretigene Neparvovec-rzyl (Luxturna™)
- Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
- Acupuncture (Independence)
Added 1/28/2019;
- Always Bundled Procedure Codes
- Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
- Arthroscopic Electrothermal Joint Repair
- Artificial Intervertebral Disc Insertion
- Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions
- Autonomic Nervous System Testing
- Botulinum Toxin Agents
- Canakinumab (Ilaris®)
- Denervation of the Spinal Nerves for Chronic Pain
- Diagnostic Radiology Services Included in Capitation
- Durable Medical Equipment (DME) and Consumable Medical Supplies
- Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management
- Eribulin Mesylate (Halaven®)
- Eribulin Mesylate (Halaven®) – Attachment
- Erythropoiesis-Stimulating Agents (ESAs)
- Erythropoiesis-Stimulating Agents (ESAs)
- Esophagogastroduodenoscopy (EGD) and Endoscopic Retrograde Cholangiopancreatography (ERCP)
- Experimental/Investigational Services
- High-Technology Radiology Services (Independence)
- Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
- Magnetoencephalography (MEG) with Magnetic Source Imaging (MSI)
- Meniscal Allograft Transplantation
- Microprocessor-Controlled Prostheses for Lower-Extremity Amputees
- Musculoskeletal Services (Independence)
- Obsolete or Unreliable Diagnostic Tests and Medical Services
- Pediatric Intensive Day Feeding Program
- Pediatric Intensive Day Feeding Program
- Percutaneous Vertebroplasty, Kyphoplasty, and Sacroplasty
- Physical Medicine, Rehabilitation, and Habilitation Services
- Physical Medicine, Rehabilitation, and Habilitation Services
- Prolonged Face-to-Face Physician Services
- Proton Beam Radiation Therapy
- Radiation Therapy Services (Independence)
- Radiation Therapy Services (Independence) – Attachment
- Spinal Cord and Dorsal Root Ganglion Stimulation
- Spinal Discectomy
- Spinal Fusion
- Spinal Laminectomy
- Trigger Point Injections
- Use of an Operating Microscope During a Surgical Procedure
- Vagus Nerve Stimulation (VNS)
- Ventricular Assist Devices (VADs)
- Voretigene Neparvovec-rzyl (Luxturna™)
Click here to view the Independence Blue Cross Medical Policy Updates »
Policy Alerts monitors Commercial and Medicare medical policies for changes. While medical Insurance carriers typically update medical policies annually, there are many reasons why they might review or update a policy. When reviews occur out of cycle they often go unnoticed. Policy Alerts keeps you updated when Payers make coverage changes to medical policies affecting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on medical Insurance decisions in real-time. When changes occur, instant email alerts are delivered to your inbox. Clients have access to detailed coverage reports and medical policies through the interactive Policy Alerts Dashboard portal. Save time each month and keep focused on important Payer medical policy reviews and coverage decisions affecting your business!
Policy Alerts takes a client-focused hands-on approach and is constantly working to provide our customers with helpful insights and actionable analytics. We understand what our clients need and are dedicated to providing timely, accurate, and always up-to-date reports.
Health economic and reimbursement information provided by Policy Alerts is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. All product and company names are trademarks™ or registered® trademarks of their respective holders. Use of them does not imply any affiliation with or endorsement by them. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.