All Insurance Policy Changes (Page 1122)

Continuing from page 1121. 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
MA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Independence Blue Cross·Effective Jun 16, 2025
Policy MA08.018j updates medical necessity criteria and medical coding requirements for trastuzumab (Herceptin®), related biosimilars, and trastuzumab with hyaluronidase-oysk (Herceptin Hylecta). The billing team must review updated medical necessity documentation requirements and ensure coding aligns with the new policy effective June 16, 2025.
Medium impact
MA08.114h, Fam-trastuzumab deruxtecan-nxki (Enhertu®)
Independence Blue Cross·Effective Jun 16, 2025
Medicare Advantage has updated medical necessity criteria for fam-trastuzumab deruxtecan-nxki (Enhertu®), a targeted cancer therapy drug. This affects prior authorization requirements and coverage criteria for this specialty oncology medication.
Medium impact
Updated Preventive Coverage for Colorectal Cancer Screening and Ultrasound Abdominal Aortic Aneurysm (AAA) Screening for Medicare Advantage members (Retroactively Effective)
Independence Blue Cross·Identified Jun 19, 2026
Medicare Advantage plans have updated preventive coverage for colorectal cancer screening and ultrasound abdominal aortic aneurysm (AAA) screening, effective retroactively. Billing teams must verify coverage parameters and adjust claims processing for these preventive services to ensure proper reimbursement and avoid denials for MA members.
Medium impact
MA08.007ar, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage updated their policy MA08.007ar regarding crossover drugs between Medicare Part B and Part D coverage. This policy clarifies billing and coverage determination for drugs that may be covered under either Medicare benefit.
Medium impact
MA08.181a, Zolbetuximab-clzb (Vyloy®)
Independence Blue Cross·Effective Jul 1, 2025
A new Medicare Advantage policy for Zolbetuximab-clzb (Vyloy®) has been updated, effective July 1, 2025. This appears to be a pharmacy-related policy change that may affect coverage, prior authorization, or billing requirements for this specialty oncology medication.
Medium impact
MA08.120f, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage policy MA08.120f for Nivolumab (Opdivo®) and Nivolumab with Hyaluronidase-nvhy (Opdivo Qvantig™) has been updated with new coverage criteria. This affects billing for these cancer immunotherapy drugs under Medicare Advantage plans.
Medium impact
MA08.182a, Zanidatamab-hrii (Ziihera®)
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage has updated its policy for Zanidatamab-hrii (Ziihera®), a new oncology medication. This pharmacy policy change affects coverage and billing requirements for this specific drug therapy used in cancer treatment.
Medium impact
MA08.073s, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors
Independence Blue Cross·Effective Jul 1, 2025
This is a new Medicare Advantage policy (MA08.073s) effective July 1, 2025, establishing coverage and billing guidelines for intravitreal injections of VEGF antagonists, VEGF biosimilars, and combination VEGF/Ang-2 inhibitors. The billing team must verify prior authorization requirements, covered medications, and any quantity limits or frequency restrictions for these ophthalmic injectable drugs before processing claims.
Medium impact
MA08.004y, Coagulation Factors
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage policy MA08.004y regarding Coagulation Factors has been updated with an effective date of July 1, 2025. This is a fresh policy change that may affect billing procedures, coverage criteria, or prior authorization requirements for coagulation factor treatments.
Medium impact
MA11.004o, Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage policy MA11.004o has been updated regarding minimally invasive treatments for urinary outlet obstruction due to benign prostatic hyperplasia (BPH). This policy change affects coverage criteria and billing requirements for BPH procedures under Medicare Advantage plans.
Medium impact
MA11.015ad, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Independence Blue Cross·Effective Jul 1, 2025
Policy MA11.015ad addresses coverage and billing requirements for skin substitute products used in the treatment of burns and chronic, non-healing wounds. This recent Medicare Advantage policy (effective 07/01/2025) requires the billing team to verify coverage criteria, prior authorization requirements, and applicable HCPCS codes for skin substitute claims to ensure proper reimbursement and avoid denials.
Medium impact
MA05.047o, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage has updated the medical policy for Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults, effective July 1, 2025. This policy change affects coverage criteria and potentially billing requirements for sleep apnea treatments and procedures.
Medium impact
MA00.003ad, Preventive Care Services
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage has updated their preventive care services policy MA00.003ad effective July 1, 2025. This policy change affects coverage, billing, or documentation requirements for preventive care services under Medicare Advantage plans.
Medium impact
MA11.049h, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage policy MA11.049h regarding bone-anchored (osseointegrated) hearing aids and implantable middle ear hearing aids has been updated. This policy affects coverage and billing for specialized hearing device procedures and implants.
Medium impact
MA11.002o, Hematopoietic Stem Cell Transplantation
Independence Blue Cross·Effective Jul 1, 2025
Medicare Advantage policy MA11.002o regarding Hematopoietic Stem Cell Transplantation has been updated with changes effective July 1, 2025. This policy covers stem cell transplant procedures and related services, though specific details require reviewing the full policy document.
Medium impact
MA05.025f, Pressure-Reducing Support Surfaces
Independence Blue Cross·Effective Jul 23, 2025
Medicare Advantage policy MA05.025f for pressure-reducing support surfaces has been reissued and will become effective July 23, 2025. This policy update affects coverage and billing requirements for therapeutic mattresses, overlays, and other pressure-relief devices typically used for wound care and pressure ulcer prevention.
Medium impact
MA11.047e, Surgical Procedures of the Eyelid and Brow
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA11.047e covering surgical procedures of the eyelid and brow has been reissued with an effective date of July 9, 2025. This is a policy reissuance that may contain updated coverage criteria, prior authorization requirements, or billing guidelines for eyelid and brow surgeries.
Medium impact
MA11.093a, Surgical Treatments of Athletic Pubalgia
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA11.093a covering surgical treatments for athletic pubalgia (sports hernia) has been reissued effective July 9, 2025. This policy update affects coverage criteria and potentially prior authorization requirements for surgical procedures treating groin pain in athletes.
Medium impact
MA11.062c, Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Independence Blue Cross·Effective Jul 9, 2025
Policy MA11.062c regarding endovascular stent graft repair of thoracic aortic aneurysms and nonaneurysmal lesions was reissued effective July 9, 2025. This is a recent policy update (1 month old) that the billing team must review for any changes to coverage criteria, prior authorization requirements, or billing guidelines for thoracic aortic procedures.
Medium impact
MA06.001f, Apheresis Therapy
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA06.001f for Apheresis Therapy has been reissued with an effective date of July 9, 2025. This appears to be a policy update that may affect coverage criteria, billing requirements, or documentation standards for apheresis procedures.
Medium impact
MA07.030c, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA07.030c for Photodynamic Therapy (PDT) using Porfimer Sodium (Photofrin®) has been reissued and becomes effective July 9, 2025. This is a fresh pharmacy-related policy update that may impact coverage or billing requirements for this specialized cancer treatment.
Medium impact
MA08.026k, Treatments for Complex Regional Pain Syndrome (CRPS)
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA08.026k for Complex Regional Pain Syndrome (CRPS) treatments has been reissued with updates effective July 9, 2025. This policy change may affect coverage criteria, prior authorization requirements, or billing procedures for CRPS-related treatments and procedures.
Medium impact
MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA10.003j for Outpatient Physical Medicine and Rehabilitation Services (PT/OT) has been reissued and will become effective July 9, 2025. This is a policy update that may affect coverage, billing, or documentation requirements for physical and occupational therapy services.
Medium impact
MA02.004a, Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA02.004a regarding Skilled Nursing Facility (SNF) skilled and subacute levels of care has been reissued with an effective date of July 9, 2025. This is a policy reissuance rather than a new policy change, suggesting updates to existing SNF coverage guidelines.
Low impact
MA05.022a, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)
Independence Blue Cross·Effective Jul 9, 2025
Medicare Advantage policy MA05.022a regarding home-use light box treatment for Seasonal Affective Disorder (SAD) has been reissued with an effective date of July 9, 2025. This appears to be a policy update that may affect coverage criteria or billing requirements for light therapy devices used to treat SAD.

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Archive by year

2023 2024 2025 2026

MA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

MA08.114h, Fam-trastuzumab deruxtecan-nxki (Enhertu®)

Updated Preventive Coverage for Colorectal Cancer Screening and Ultrasound Abdominal Aortic Aneurysm (AAA) Screening for Medicare Advantage members (Retroactively Effective)

MA08.007ar, Medicare Part B vs. Part D Crossover Drugs

MA08.181a, Zolbetuximab-clzb (Vyloy®)

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

MA08.182a, Zanidatamab-hrii (Ziihera®)

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

MA08.004y, Coagulation Factors

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

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

MA05.047o, Treatment of Obstructive Sleep Apnea (OSA) and Primary Snoring in Adults

MA00.003ad, Preventive Care Services

MA11.049h, Bone-Anchored (Osseointegrated) Hearing Aids and Implantable Middle Ear Hearing Aids

MA11.002o, Hematopoietic Stem Cell Transplantation

MA05.025f, Pressure-Reducing Support Surfaces

MA11.047e, Surgical Procedures of the Eyelid and Brow

MA11.093a, Surgical Treatments of Athletic Pubalgia

MA11.062c, Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions

MA06.001f, Apheresis Therapy

MA07.030c, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)

MA08.026k, Treatments for Complex Regional Pain Syndrome (CRPS)

MA10.003j, Outpatient Physical Medicine and Rehabilitation Services- Physical Therapy (PT) and Occupational Therapy (OT)

MA02.004a, Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care

MA05.022a, Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)