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Click here to view the Independence Blue Cross Medical Policy Updates »
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Spinal Cord and Dorsal Root Ganglion Stimulation
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Attachment A (ICD-10-CM Codes) to 11.15.01r Spinal Cord and Dorsal Root Ganglion Stimulation
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Cast and Splint Applications and Associated Supplies Provided in the Office Setting
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Attachment A to 00.10.15c Cast and Splint Applications and Associated Supplies Provided in the Office Setting
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Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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Attachment A1 (CPT CODES INCLUDED IN CAPITATION TO THE PCP’S DESIGNATED LABORATORY SITE) to 00.03.07t Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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Attachment A2 (HCPCS CODES INCLUDED IN CAPITATION TO THE PCP’S DESIGNATED LABORATORY SITE) to 00.03.07t Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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Attachment B1 (SERVICES ELIGIBLE FOR REIMBURSEMENT WHEN PERFORMED IN THE SPECIALIST OFFICE (THIS INCLUDES THE CERTIFIED REGISTERED NURSE PRACTITIONER (CRNP) AND PHYSICIAN ASSISTANT (PA) PRACTICING WITHIN THE SCOPE OF THEIR SPECIALTY) ) to 00.03.07t Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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Attachment B2 (SERVICES ELIGIBLE FOR REIMBURSEMENT IN THE OUTPATIENT HOSPITAL LABORATORY) to 00.03.07t Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
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Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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Attachment A (High Risk Pregnancy) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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Attachment B (Rule out Ectopic Pregnancy) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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Attachment C (Rule out intrauterine pathology and Screening for Fetal abnormalities) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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Attachment D (First-trimester screening and Ovarian Dysfunction) to 00.03.10e Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
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PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment A1 (DME Network Rules and Limited Circumstances) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment A2 (DME Network Rules and Limited Circumstances cont’d.) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment A3 (DME Network Rules and Limited Circumstances) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment B1 (Laboratory Network Rules and Limited Circumstances) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment B2 (Laboratory Network Rules and Limited Circumstances cont’d.) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment B3 (Laboratory Network Rules and Limited Circumstances cont’d.) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment C1 (Radiology Network Rules and Limited Circumstances) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment C2 (Radiology Network Rules and Limited Circumstances cont’d.) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Attachment D (Physical Medicine & Rehabilitation Network Rules and Limited Circumstances) to 00.01.25ao PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
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Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs)
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Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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Attachment A: DELAWARE (Delaware Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers) to 00.10.01y Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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Attachment B: NEW JERSEY (New Jersey Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers) to 00.10.01y Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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Attachment C: PENNSYLVANIA (Pennsylvania Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers ) to 00.10.01y Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
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X-rays Associated with Fractures in the Office Setting
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Attachment A (HAND SURGEON, ORTHOPEDIC SURGEON, OR SPORTS MEDICINE SPECIALIST) to 00.03.09d X-rays Associated with Fractures in the Office Setting
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Attachment B (PODIATRIST) to 00.03.09d X-rays Associated with Fractures in the Office Setting
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Repair or Replacement of an External Prosthetic Device
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Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence
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Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
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Attachment A (Risk of Emesis Without Prophylaxis: Intravenous and Oral Antineoplastic Agents) to 08.01.41 Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)
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C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®
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Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company’s Medical Benefit
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Lanreotide (Somatuline® Depot)
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Attachment A (ICD-10 CODES AND NARRATIVES) to 08.01.40 Lanreotide (Somatuline® Depot)
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Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
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Preventive Care Services (Independence)
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Attachment A (Adult Preventive Services) to 00.06.02u Preventive Care Services (Independence)
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Attachment B (Female Preventive Care Services) to 00.06.02u Preventive Care Services (Independence)
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Attachment C (Pediatric Preventive Care Services) to 00.06.02u Preventive Care Services (Independence)
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Self-Administered Drugs
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Attachment A (Prescription drugs that are considered by the Company to be self-administered.) to 08.00.78x Self-Administered Drugs
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Musculoskeletal Services
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Attachment A (Procedure Codes for Spinal Surgery) to 00.01.66 Musculoskeletal Services
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Attachment B (Procedure Codes for Joint Surgery) to 00.01.66 Musculoskeletal Services
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Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound
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Attachment A (Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound Code List) to 11.02.27 Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound
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Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
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Attachment A (ICD-10 codes ) to 11.05.16f Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma
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Laboratory-Based Vestibular Function Testing
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Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)
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Attachment A (ICD-10 Codes) to 08.00.08i Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)
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Routine Foot Care for Certain Medical Conditions
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Attachment A (ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (A30.0 -E10.21)) to 07.07.01m Routine Foot Care for Certain Medical Conditions
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Attachment B (ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (E10.22 – E13.3512), Continued) to 07.07.01m Routine Foot Care for Certain Medical Conditions
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Attachment C (ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (E13.3513 – I87.093), Continued) to 07.07.01m Routine Foot Care for Certain Medical Conditions
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Attachment D (ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (I87.099 – S86.891S), Continued) to 07.07.01m Routine Foot Care for Certain Medical Conditions
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Attachment E (ICD-10 CM Codes Eligible to be Reported for Routine Foot Care for Certain Medical Conditions (S86.892A – Z79.01), Continued) to 07.07.01m Routine Foot Care for Certain Medical Conditions |
Click here to view the Independence Blue Cross Medical Policy Updates »
Policy Alerts monitors Commercial and Medicare medical policies for changes. While Payers typically update medical policies annually, there are many reasons why a Payer might review or update a policy. When reviews occur out of cycle, they may go unnoticed. Policy Alerts keeps you informed of upcoming and unexpected coverage changes affecting your product. Quickly understanding the changes Payers make can help you adjust reimbursement strategies impacting your business.
Policy Alerts continuously monitors Commercial and Medicare Payer coverage information to keep you up-to-date on Payer decisions in real-time. Whenever changes occur, email notifications containing a summary of those changes are delivered to your inbox. Clients can access detailed coverage reports and medical policies on the interactive Dashboard portal. Save time and keep focused on the important Payer medical policy reviews and coverage decisions affecting your product!
Policy Alerts takes a client-focused hands-on approach and works hard to provide our customers with helpful insights and actionable analytics over raw data. We understand what our clients need and we are dedicated to making sure we provide timely, accurate and always up-to-date reports that can be used to implement and support a successful reimbursement strategy.
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. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.
