All Insurance Policy Changes (Page 1113)

Continuing from page 1112. Showing older policy changes tracked across all payers. Use the filters in the related-hubs section below to narrow by provider, state, or specialty.

Medium impact
MA07.040c, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies
Independence Blue Cross·Effective Mar 5, 2025
Policy MA07.040c regarding Transcatheter Arterial Chemoembolization (TACE) for hepatic malignancies has been reissued effective March 5, 2025. This is a recent policy update that may contain changes to coverage criteria, prior authorization requirements, or billing guidelines for TACE procedures. The billing team must review the full policy details to identify specific changes from the previous version.
Low impact
MA08.154a, olipudase alfa-rpcp (Xenpozyme®)
Independence Blue Cross·Effective Mar 5, 2025
Medicare Advantage policy MA08.154a for olipudase alfa-rpcp (Xenpozyme®) has been reissued and updated. This is a pharmacy policy change affecting coverage or authorization requirements for this enzyme replacement therapy medication used to treat acid sphingomyelinase deficiency.
Medium impact
MA03.008c, Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period
Independence Blue Cross·Effective Mar 5, 2025
This policy reissue (effective 03/05/2025) clarifies the proper use of Modifier 78 for unplanned returns to the operating/procedure room by the same or other qualified provider for a related procedure during the postoperative period. Billing teams must ensure accurate modifier application to avoid claim denials and ensure appropriate reimbursement for legitimate unplanned return procedures.
Medium impact
MA03.018b, Modifier 53: Discontinued Procedure
Independence Blue Cross·Effective Mar 5, 2025
Medicare Advantage has reissued policy MA03.018b regarding Modifier 53 for discontinued procedures, effective March 5, 2025. This policy update affects how billing teams should handle and code procedures that are discontinued or terminated before completion.
Medium impact
MA09.008a, Low Osmolar Contrast Agents
Independence Blue Cross·Effective Mar 5, 2025
Medicare Advantage policy MA09.008a regarding Low Osmolar Contrast Agents has been reissued with an effective date of March 5, 2025. This is a policy update that may affect billing and coverage requirements for procedures using low osmolar contrast agents.
Medium impact
MA03.012d, Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
Independence Blue Cross·Effective Mar 5, 2025
This policy clarifies the use of Modifier 79 for Medicare Advantage plans when a physician or qualified healthcare professional provides an unrelated procedure or service during a patient's postoperative period. Modifier 79 must be appended to indicate the procedure is unrelated to the original surgery, ensuring proper billing and avoiding claim denials for legitimate concurrent services.
Medium impact
MA03.009e, Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period
Independence Blue Cross·Effective Mar 5, 2025
This policy clarifies the use of Modifier 24 for billing unrelated Evaluation and Management (E/M) services by the same physician during a postoperative period under Medicare Advantage plans. Billing teams must ensure proper documentation and modifier application to distinguish unrelated E/M visits from postoperative global period services to avoid claim denials.
Medium impact
MA00.038b, Marijuana for Medical Use
Independence Blue Cross·Effective Mar 5, 2025
Medicare Advantage policy MA00.038b regarding marijuana for medical use has been reissued with an effective date of March 5, 2025. This is a policy update that affects coverage or billing guidelines for medical marijuana-related services under Medicare Advantage plans.
Medium impact
MA11.004n, Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Effective Mar 24, 2025
Policy MA11.004n establishes medical necessity criteria, coding guidelines, and coverage updates for minimally invasive treatments addressing urinary outlet obstruction due to benign prostatic hyperplasia (BPH). This recent policy (effective 03/24/2025) updates medical necessity requirements, billing code guidance, and general informational parameters for BPH treatment procedures. Billing teams must review updated criteria to ensure claims meet current medical necessity standards and use correct coding.
Medium impact
MA08.120e, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Independence Blue Cross·Effective Mar 24, 2025
Policy MA08.120e updates medical necessity criteria, medical coding guidelines, and general informational content for Nivolumab (Opdivo®) and Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™). This recent Medicare Advantage policy change affects how these immunotherapy drugs are authorized, coded, and billed. Billing teams must review updated medical necessity criteria and coding requirements to ensure compliant claim submission.
Medium impact
MA08.117e, Isatuximab-irfc (Sarclisa®)
Independence Blue Cross·Effective Mar 24, 2025
Policy MA08.117e establishes medical necessity criteria, billing coding requirements, and updated guidelines for isatuximab-irfc (Sarclisa®), a monoclonal antibody used in multiple myeloma treatment. This recent policy (effective 03/24/2025) requires billing and clinical teams to align coding practices and ensure documentation supports medical necessity for this specialty pharmaceutical.
Medium impact
MA08.024m, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)
Independence Blue Cross·Effective Mar 24, 2025
Policy MA08.024m updates medical necessity criteria, medical coding guidelines, and general informational content for IL-5 antagonist and IL-5 receptor antagonist medications (Cinqair®, Nucala®, Fasenra®). This recent change (effective 03/24/2025) requires billing and clinical teams to align documentation, coding practices, and prior authorization submissions with new medical necessity standards for these biologics used in asthma and eosinophilic conditions.
High impact
MA11.113k, Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound
Independence Blue Cross·Effective Mar 24, 2025
Policy MA11.113k updates medical necessity criteria for Percutaneous Coronary Intervention (PCI), Coronary Angiography, and Arterial Ultrasound effective March 24, 2025. This recent policy change establishes new requirements for Medicare Advantage plans and may affect prior authorization workflows, documentation requirements, and claim adjudication for cardiac interventional procedures.
Medium impact
MA08.165b, Epcoritamab-bysp (EPKINLY®)
Independence Blue Cross·Effective Mar 24, 2025
Policy MA08.165b establishes medical necessity criteria, coding guidelines, and updated informational requirements for Epcoritamab-bysp (EPKINLY®), a newly covered pharmacy/oncology drug. This policy update affects how claims are coded, what documentation is required to support medical necessity, and billing workflows for this specific therapeutic agent.
Medium impact
MA09.002ad, High-Technology Radiology Services
Independence Blue Cross·Effective Mar 23, 2025
Medicare Advantage policy MA09.002ad for High-Technology Radiology Services has been updated with general description, guidelines, or informational changes. This is a recent update to an existing radiology policy that will take effect March 23, 2025.
Medium impact
MA06.001f, Apheresis Therapy
Independence Blue Cross·Effective Mar 17, 2025
Policy MA06.001f on Apheresis Therapy has been updated with changes to medical necessity criteria, medical coding, and general guidelines/informational content. This recent update (effective 03/17/2025) requires the billing team to review and implement new requirements for apheresis therapy authorization and billing on Medicare Advantage plans.
Medium impact
MA08.179, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·Effective Mar 24, 2025
A new Medicare Advantage policy MA08.179 has been established for Guselkumab (Tremfya®) injection for intravenous use, effective March 24, 2025. This new pharmacy policy will likely establish coverage criteria and requirements for this specialty biologic medication used primarily for inflammatory conditions.
High impact
MA00.010at, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·Effective Apr 1, 2025
This policy establishes PPO Network Rules for specialty services including Durable Medical Equipment (DME), Laboratory, Radiology, and Physical Medicine/Rehabilitative Services under Medicare Advantage plans. The policy, effective April 1, 2025, defines network requirements and billing rules for these service categories that billing teams must implement immediately.
Medium impact
MA05.045f, Compression Garments
Independence Blue Cross·Effective Apr 1, 2025
Policy MA05.045f regarding Compression Garments for Medicare Advantage plans has been updated effective April 1, 2025. The full policy details are not provided in the source material, so the specific coverage changes, billing code impacts, or prior authorization requirements cannot be determined from the information available.
Medium impact
MA05.062l, Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
Independence Blue Cross·Effective Apr 9, 2025
Medicare Advantage policy MA05.062l regarding repair and replacement of Durable Medical Equipment (DME) and prosthetic devices has been updated as of April 9, 2025. This is a very recent policy change that may affect coverage criteria, billing requirements, or documentation standards for DME and prosthetic device claims.
Medium impact
MA00.030ah, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA00.030ah regarding laboratory services for HMO and HMO-POS members has been updated. This policy change affects laboratory billing and coverage requirements for Medicare Advantage members enrolled in HMO or HMO Point-of-Service products, effective April 1, 2025.
Medium impact
MA09.009x, Reimbursement for Radiopharmaceutical Agents for Professional Providers
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage has updated their reimbursement policy for radiopharmaceutical agents used by professional providers. This policy change affects how providers will be reimbursed for radiopharmaceuticals used in diagnostic and therapeutic procedures.
High impact
MA03.003q, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service
Independence Blue Cross·Effective Apr 1, 2025
This policy clarifies the requirements for applying Modifier 25 to Evaluation and Management (E/M) services billed on the same day as a procedure or other service by the same provider. The policy defines what constitutes a 'significant, separately identifiable' E/M service under Medicare Advantage plans effective April 1, 2025. Billing teams must ensure proper documentation and modifier application to avoid claim denials.
Medium impact
MA05.044t, Durable Medical Equipment (DME)
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage has updated their Durable Medical Equipment (DME) policy MA05.044t, effective April 1, 2025. This is a fresh policy update that may affect coverage, prior authorization, or billing requirements for DME items and supplies.
Medium impact
MA11.106k, Gender-Affirming Interventions
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA11.106k regarding Gender-Affirming Interventions has been updated with an effective date of April 1, 2025. This is a very recent policy change that may affect coverage criteria, prior authorization requirements, or billing procedures for gender-affirming medical services.

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Archive by year

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MA07.040c, Transcatheter Arterial Chemoembolization (TACE) of Hepatic Malignancies

MA08.154a, olipudase alfa-rpcp (Xenpozyme®)

MA03.008c, Modifier 78: Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

MA03.018b, Modifier 53: Discontinued Procedure

MA09.008a, Low Osmolar Contrast Agents

MA03.012d, Modifier 79: Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

MA03.009e, Modifier 24: Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a Postoperative Period

MA00.038b, Marijuana for Medical Use

MA11.004n, Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)

MA08.120e, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)

MA08.117e, Isatuximab-irfc (Sarclisa®)

MA08.024m, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair®, Nucala®) and IL-5 Receptor Antagonist (e.g., Fasenra®)

MA11.113k, Percutaneous Coronary Intervention, Coronary Angiography, and Arterial Ultrasound

MA08.165b, Epcoritamab-bysp (EPKINLY®)

MA09.002ad, High-Technology Radiology Services

MA06.001f, Apheresis Therapy

MA08.179, Guselkumab (Tremfya®) Injection for Intravenous Use

MA00.010at, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

MA05.045f, Compression Garments

MA05.062l, Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices

MA00.030ah, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

MA09.009x, Reimbursement for Radiopharmaceutical Agents for Professional Providers

MA03.003q, Modifier 25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

MA05.044t, Durable Medical Equipment (DME)

MA11.106k, Gender-Affirming Interventions