All Insurance Policy Changes (Page 1114)

Continuing from page 1113. 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
MA08.004x, Coagulation Factors
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA08.004x for Coagulation Factors has been updated with changes effective April 1, 2025. This policy likely affects coverage criteria, prior authorization requirements, or billing procedures for coagulation factor treatments and related hemophilia/bleeding disorder services.
Medium impact
MA08.073r, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Apr 1, 2025
This is a new Medicare Advantage policy (MA08.073r) effective April 1, 2025, establishing coverage guidelines for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors. The policy likely includes prior authorization requirements, medical necessity criteria, and coverage rules for these retinal disease treatments. Billing teams must review the full policy text to identify specific billing codes, authorization requirements, and any documentation mandates.
Medium impact
MA08.127e, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)
Independence Blue Cross·Effective Apr 1, 2025
This is a new pharmacy policy (MA08.127e) effective April 1, 2025, covering Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) for Medicare Advantage plans. The policy establishes coverage criteria, prior authorization requirements, and billing guidelines for these immunotherapy drugs used primarily in oncology.
Medium impact
MA11.015ac, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA11.015ac for wound care skin substitutes used in treating burns and chronic, non-healing wounds has been updated effective April 1, 2025. This policy change affects coverage and billing requirements for skin substitute products and procedures used in wound care treatment.
Low impact
MA08.044k, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA08.044k for Eculizumab (Soliris®) and related biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration has been updated. This affects coverage and billing for these specialty medications used to treat rare blood disorders like paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome.
Medium impact
MA08.130h, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA08.130h regarding Filgrastim (Neupogen®), related biosimilars, and Tbo-filgrastim (Granix®) has been updated effective April 1, 2025. This is a fresh pharmacy policy update that may affect coverage and billing requirements for these specific medications used to stimulate white blood cell production.
Medium impact
MA00.002r, Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA00.002r for Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies has been updated, effective April 1, 2025. This policy change affects billing and coverage requirements for glucose monitoring devices and supplies for Medicare Advantage beneficiaries.
Medium impact
MA05.057d, Upper-Limb Prostheses
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA05.057d for Upper-Limb Prostheses has been updated with new coverage criteria or billing requirements. This policy change affects prosthetic device coverage and may impact authorization processes or documentation requirements for upper extremity prosthetics.
Medium impact
MA05.043d, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA05.043d regarding mechanical stretching devices for joint stiffness or contractures has been updated effective April 1, 2025. This policy change affects coverage and billing requirements for mechanical stretching devices used in treating joint contractures.
Medium impact
MA11.002n, Hematopoietic Stem Cell Transplantation
Independence Blue Cross·Effective Apr 1, 2025
Medicare Advantage policy MA11.002n for Hematopoietic Stem Cell Transplantation has been updated with new requirements effective April 1, 2025. This affects billing and coverage for stem cell transplant procedures under Medicare Advantage plans.
High impact
MA00.001e, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
Independence Blue Cross·Effective Apr 1, 2025
Policy MA00.001e establishes criteria for identifying and denying coverage of services deemed not medically necessary and obsolete or unreliable diagnostic tests under Medicare Advantage plans effective April 1, 2025. Billing teams must implement processes to identify claims that may violate this policy and ensure proper documentation of medical necessity before submission to avoid denials.
Medium impact
MA05.032c, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices Policy #MA05.032c
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA05.032c for Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices has been reissued and will take effect April 30, 2025. This policy update may affect coverage criteria, prior authorization requirements, or documentation standards for durable medical equipment related to mobility devices.
Medium impact
MA11.101, Nucleoplasty
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA11.101 for Nucleoplasty has been reissued and updated. This is a fresh policy change that may affect coverage or billing requirements for nucleoplasty procedures under Medicare Advantage plans.
Medium impact
MA08.060g, Pegloticase (Krystexxa®)
Independence Blue Cross·Effective Apr 30, 2025
The Medicare Advantage policy for Pegloticase (Krystexxa®) has been reissued with updates, though specific changes are not detailed in the summary. This medication is used for treatment-refractory chronic gout and may affect billing and coverage requirements.
Low impact
MA08.126b, Inebilizumab-cdon (Uplizna)
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA08.126b for Inebilizumab-cdon (Uplizna) has been reissued and will be effective April 30, 2025. This is a pharmacy policy update that may affect coverage or authorization requirements for this specialty medication used to treat neuromyelitis optica spectrum disorders.
Medium impact
MA11.077h, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·Effective Apr 30, 2025
Policy MA11.077h regarding prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy was reissued effective 04/30/2025. This recent update supersedes older guidance on these preventive surgical procedures. The billing team must review the full policy text to identify any changes to coverage criteria, prior authorization requirements, or billing code applications for these procedures.
Medium impact
MA05.020h, Therapeutic Shoes
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA05.020h for Therapeutic Shoes has been reissued and will take effect on April 30, 2025. This is a policy update affecting therapeutic shoe coverage and billing requirements for Medicare Advantage members.
Medium impact
MA11.069f, Reduction Mammoplasty
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA11.069f for Reduction Mammoplasty has been reissued and will take effect April 30, 2025. This is a policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for breast reduction surgeries under Medicare Advantage plans.
Medium impact
MA11.070d, Lipectomy and Liposuction
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA11.070d covering Lipectomy and Liposuction procedures has been reissued with updates effective April 30, 2025. This is a fresh policy change that may affect coverage criteria, prior authorization requirements, or billing guidelines for cosmetic and reconstructive fat removal procedures.
Medium impact
MA11.025, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA11.025 for Percutaneous Intradiscal Annuloplasty (IDET/PIRFT) has been reissued and will take effect April 30, 2025. This affects billing for minimally invasive spine procedures used to treat chronic lower back pain from disc degeneration.
Medium impact
MA05.010k, Ankle-Foot/Knee-Ankle-Foot Orthoses
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA05.010k for Ankle-Foot/Knee-Ankle-Foot Orthoses has been reissued and will be effective April 30, 2025. This is a policy update that may affect coverage criteria, billing requirements, or documentation standards for orthotic devices.
Medium impact
MA08.097a, Triamcinolone Acetonide ER Injectable (Zilretta®)
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA08.097a for Triamcinolone Acetonide ER Injectable (Zilretta®) has been reissued and becomes effective April 30, 2025. This is a fresh pharmacy policy update that may affect coverage or billing requirements for this injectable medication used primarily for osteoarthritis treatment.
Medium impact
MA11.017j, Trigger Point Injections
Independence Blue Cross·Effective Apr 30, 2025
Medicare Advantage policy MA11.017j for Trigger Point Injections has been reissued and will become effective April 30, 2025. This is a fresh policy update that may contain changes to coverage, prior authorization, or billing requirements for trigger point injection procedures.
Medium impact
MA07.038k, Neuropsychological Testing for Neurologically Based Conditions
Independence Blue Cross·Effective Nov 26, 2024
Policy MA07.038k establishes coverage criteria and guidelines for neuropsychological testing in Medicare Advantage plans for patients with neurologically based conditions. This reissue (effective 11/26/2024) updates prior guidance and requires billing teams to verify medical necessity documentation and authorization requirements before submitting claims for neuropsychological testing services.
Medium impact
MA07.009i, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross·Effective Apr 16, 2025
Medicare Advantage policy MA07.009i for routine foot care for certain medical conditions has been reissued and will take effect on April 16, 2025. This is a policy update that may affect coverage criteria or billing requirements for foot care services provided to Medicare Advantage patients with qualifying medical conditions.

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MA08.004x, Coagulation Factors

MA08.073r, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors

MA08.127e, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)

MA11.015ac, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds

MA08.044k, Eculizumab (Soliris®) and Related Biosimilars, Ravulizumab-cwvz (Ultomiris™) for intravenous administration

MA08.130h, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)

MA00.002r, Continuous Glucose Monitors and Home Blood Glucose Monitors and Supplies

MA05.057d, Upper-Limb Prostheses

MA05.043d, Mechanical Stretching Devices for the Treatment of Joint Stiffness or Contractures

MA11.002n, Hematopoietic Stem Cell Transplantation

MA00.001e, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests

MA05.032c, Power Wheelchairs (PWCs), Power-Operated Vehicles (POVs), and Push-Rim-Activated Power-Assist Devices Policy #MA05.032c

MA11.101, Nucleoplasty

MA08.060g, Pegloticase (Krystexxa®)

MA08.126b, Inebilizumab-cdon (Uplizna)

MA11.077h, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

MA05.020h, Therapeutic Shoes

MA11.069f, Reduction Mammoplasty

MA11.070d, Lipectomy and Liposuction

MA11.025, Percutaneous Intradiscal Annuloplasty (IDET/PIRFT)

MA05.010k, Ankle-Foot/Knee-Ankle-Foot Orthoses

MA08.097a, Triamcinolone Acetonide ER Injectable (Zilretta®)

MA11.017j, Trigger Point Injections

MA07.038k, Neuropsychological Testing for Neurologically Based Conditions

MA07.009i, Routine Foot Care for Certain Medical Conditions