Independence Blue Cross November 2017 Medical Policy Updates

Independence Blue Cross Medical Policy Updates
Independence Blue Cross Medical Policy Updates

Click here to view the Independence Blue Cross Medical Policy Updates »

Policy Effective Date Notification Title
11/21/2017
Spinal Cord and Dorsal Root Ganglion Stimulation

 

Attachment A (ICD-10-CM Codes) to 11.15.01r Spinal Cord and Dorsal Root Ganglion Stimulation

 

12/01/2017
Cast and Splint Applications and Associated Supplies Provided in the Office Setting

 

Attachment A to 00.10.15c Cast and Splint Applications and Associated Supplies Provided in the Office Setting

 

Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

 

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

 

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

 

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

 

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

 

Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product

 

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

 

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

 

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

 

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

 

PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

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

 

Reimbursement for Services Performed by Certified Registered Nurse Practitioners (CRNPs) or Physician Assistants (PAs)

 

Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers

 

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

 

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

 

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

 

X-rays Associated with Fractures in the Office Setting

 

Attachment A (HAND SURGEON, ORTHOPEDIC SURGEON, OR SPORTS MEDICINE SPECIALIST) to 00.03.09d X-rays Associated with Fractures in the Office Setting

 

Attachment B (PODIATRIST) to 00.03.09d X-rays Associated with Fractures in the Office Setting

 

12/15/2017
Repair or Replacement of an External Prosthetic Device

 

Sacral Nerve Stimulation (SNS) and Posterior Tibial Nerve Stimulation (PTNS) for the Control of Incontinence

 

01/01/2018
Aprepitant (Cinvanti™), Fosaprepitant Dimeglumine (Emend®), Granisetron (Sustol®), and Rolapitant (Varubi®)

 

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®)

 

C1 Esterase Inhibitors: Cinryze®, Berinert®, and Ruconest®

 

Coverage of Prescription Oral Anticancer Drugs and/or Biologics as Provided Under the Company’s Medical Benefit

 

Lanreotide (Somatuline® Depot)

 

Attachment A (ICD-10 CODES AND NARRATIVES) to 08.01.40 Lanreotide (Somatuline® Depot)

 

Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

 

Preventive Care Services (Independence)

 

Attachment A (Adult Preventive Services) to 00.06.02u Preventive Care Services (Independence)

 

Attachment B (Female Preventive Care Services) to 00.06.02u Preventive Care Services (Independence)

 

Attachment C (Pediatric Preventive Care Services) to 00.06.02u Preventive Care Services (Independence)

 

Self-Administered Drugs

 

Attachment A (Prescription drugs that are considered by the Company to be self-administered.) to 08.00.78x Self-Administered Drugs

 

01/02/2018
Musculoskeletal Services

 

Attachment A (Procedure Codes for Spinal Surgery) to 00.01.66 Musculoskeletal Services

 

Attachment B (Procedure Codes for Joint Surgery) to 00.01.66 Musculoskeletal Services

 

Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound

 

Attachment A (Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound Code List) to 11.02.27 Percutaneous Coronary Intervention, Coronary Angiography and Arterial Ultrasound

 

01/30/2018
Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma

 

Attachment A (ICD-10 codes ) to 11.05.16f Aqueous Shunts, Microstents, Viscocanalostomy, and Canaloplasty for the Treatment of Glaucoma

 

02/13/2018
Laboratory-Based Vestibular Function Testing

 

02/14/2018
Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)

 

Attachment A (ICD-10 Codes) to 08.00.08i Radioimmunotherapy with Ibritumomab Tiuxetan (Zevalin®) (Independence Administrators)

 

02/15/2018
Routine Foot Care for Certain Medical Conditions

 

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

 

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

 

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

 

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

 

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 »

 

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