All Insurance Policy Changes (Page 1146)

Continuing from page 1145. 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
MA11.060h, Catheter Ablation of Cardiac Arrhythmias
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA11.060h for Catheter Ablation of Cardiac Arrhythmias has been reissued with an effective date of June 10, 2026. This is a policy update that may affect coverage criteria, billing requirements, or documentation standards for cardiac catheter ablation procedures.
Medium impact
MA11.012f, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms
Independence Blue Cross·Effective Jun 10, 2026
Policy MA11.012f regarding endovascular grafts for abdominal aortic aneurysms (AAA), aorto-iliac aneurysms, and infrarenal aortic aneurysms was reissued effective June 10, 2026. This is a recent policy update that may contain changes to coverage criteria, prior authorization requirements, or billing guidelines for endovascular graft procedures. Billing teams must review the full policy text to identify specific changes from the prior version.
Medium impact
MA07.048a, Instrument-Based Vision Screening
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA07.048a for Instrument-Based Vision Screening has been reissued and will take effect on June 10, 2026. This is a policy update that may affect coverage or billing requirements for automated vision screening procedures.
Medium impact
MA06.013e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Independence Blue Cross·Effective Jun 10, 2026
Policy MA06.013e regarding serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test was reissued effective 06/10/2026. This is a recent policy update (1 month old) that billing teams must review for any changes to coverage criteria, prior authorization requirements, or billing code updates for IBD serological testing under Medicare Advantage plans.
Medium impact
MA11.052f, Ablation of Lung Tumors
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA11.052f for lung tumor ablation procedures has been reissued and will take effect June 10, 2026. This is a policy update that may affect coverage criteria, billing requirements, or documentation standards for ablation procedures targeting lung tumors.
Low impact
MA11.115, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA11.115 for Direct Endoscopic Necrosectomy (DEN) for pancreatic necrosis treatment has been reissued with updates effective June 10, 2026. This is a specialized gastroenterology procedure policy that may affect coverage criteria or billing requirements for this specific endoscopic treatment.
Low impact
MA07.006d, Fecal Microbiota Transplantation (FMT)
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA07.006d for Fecal Microbiota Transplantation (FMT) has been reissued and will take effect June 10, 2026. This is a policy update that may affect coverage criteria, billing requirements, or documentation standards for FMT procedures.
Medium impact
MA11.055g, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA11.055g for GERD treatment procedures has been reissued and will take effect June 10, 2026. This is a policy update that may affect coverage, billing, or authorization requirements for gastroesophageal reflux disease treatments under Medicare Advantage plans.
Medium impact
MA07.026r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross·Effective Jun 10, 2026
This is a reissue of the MA07.026r policy for Ambulatory Electrocardiography (AECG) and Mobile Cardiac Outpatient Telemetry (MCOT) monitoring effective June 10, 2026. The policy was reposted on June 11, 2026. Without access to the full policy text comparing the previous version to this reissue, billing teams should review the complete policy document to identify specific changes to coverage criteria, prior authorization requirements, billing codes, or documentation requirements.
Medium impact
MA11.062d, Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Independence Blue Cross·Effective Jun 10, 2026
Policy MA11.062d regarding endovascular stent graft repair of thoracic aortic aneurysms and nonaneurysmal lesions has been reissued effective 06/10/2026. This is a recent policy update that the billing team must review for any changes to coverage criteria, prior authorization requirements, or billing code guidance for thoracic aortic procedures.
Medium impact
MA08.016h, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents
Independence Blue Cross·Effective Jun 10, 2026
This is a reissue of the Medicare Advantage policy MA08.016h governing the treatment of pulmonary artery hypertension (PAH) using intravenous, subcutaneous, and inhaled medications. The policy took effect on 06/10/2026 and was reissued on the same date. Without access to the full policy text, the specific changes from previous versions cannot be determined; however, the billing team must review this reissued policy to identify any updates to coverage criteria, prior authorization requirements, or billing guidance for PAH pharmacologic agents.
Medium impact
MA11.097f, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis
Independence Blue Cross·Effective Jun 10, 2026
Medicare Advantage policy MA11.097f for Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis has been reissued with an effective date of June 10, 2026. This is a policy update that affects coverage and billing requirements for this specialized spine procedure under Medicare Advantage plans.
Medium impact
MA08.144c, Tezepelumab-ekko (Tezspire®)
Independence Blue Cross·Effective Jun 15, 2026
MA08.144c updates medical necessity criteria for Tezepelumab-ekko (Tezspire®), a biologic asthma treatment. This recent policy change affects how prior authorization and coverage decisions are made for this pharmacy benefit under Medicare Advantage plans. Billing teams must ensure claims align with the new medical necessity requirements to avoid denials.
Medium impact
MA08.176a, Tarlatamab-dlle (Imdelltra® for intravenous use
Independence Blue Cross·Effective Jun 15, 2026
This policy establishes medical necessity criteria for Tarlatamab-dlle (Imdelltra®), a new intravenous pharmaceutical agent. The policy change affects how claims for this medication will be processed under Medicare Advantage plans, likely requiring documentation of specific clinical criteria to support coverage and payment.
High impact
MA00.047t, Musculoskeletal Services
Independence Blue Cross·Effective Jun 14, 2026
Medicare Advantage policy MA00.047t for Musculoskeletal Services has been updated with changes to medical necessity criteria and general guidelines. This is a very recent policy change that affects musculoskeletal service coverage and billing requirements.
Medium impact
MA08.170b, Toripalimab-tpzi (Loqtorzi®)
Independence Blue Cross·Effective Jun 15, 2026
Medicare Advantage has updated the medical necessity criteria for Toripalimab-tpzi (Loqtorzi®), a pharmacy benefit drug. This change affects coverage requirements and approval processes for this specific medication effective June 15, 2026.
Medium impact
MA08.047n, Pemetrexed (Pemfexy™)
Independence Blue Cross·Effective Jun 15, 2026
Policy MA08.047n has been updated with changes to medical necessity criteria and medical coding guidelines for Pemetrexed (Pemfexy™). The billing team must review the full policy text to identify specific criteria changes and billing code impacts that affect claim submissions for this chemotherapy agent.
High impact
MA08.011i, Erythropoiesis Stimulating Agents (ESAs)
Independence Blue Cross·Effective Jun 15, 2026
Policy MA08.011i updates medical necessity criteria and medical coding requirements for Erythropoiesis Stimulating Agents (ESAs). This recent policy change affects how ESA claims are evaluated and coded for Medicare Advantage members, requiring billing and clinical teams to implement new documentation and coding standards effective immediately.
Medium impact
MA08.159d, Mirvetuximab soravtansine-gynx (Elahere®)
Independence Blue Cross·Effective Jun 15, 2026
MA08.159d updates medical necessity criteria for Mirvetuximab soravtansine-gynx (Elahere®), a pharmacy benefit drug used in oncology. This recent policy change (1 month old) affects how claims for this medication are evaluated and approved under Medicare Advantage plans. Billing teams must ensure all prescriptions meet the new medical necessity requirements to avoid claim denials.
Medium impact
MA05.046k, Wheelchair Options and Accessories
Independence Blue Cross·Effective Jun 8, 2026
Policy MA05.046k updates medical necessity criteria for wheelchair options and accessories under Medicare Advantage plans, effective June 8, 2026. The billing team must review the revised criteria to ensure proper documentation and authorization of wheelchair claims going forward.
Medium impact
MA06.001g, Apheresis Therapy
Independence Blue Cross·Effective Jun 8, 2026
Policy MA06.001g regarding Apheresis Therapy has been updated with changes to coverage and/or reimbursement position and medical necessity criteria, effective June 8, 2026. The billing team must review updated medical necessity requirements and coverage guidelines to ensure proper claim submission and reimbursement for apheresis therapy procedures.
Medium impact
MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross·Effective Jun 5, 2026
Medicare Advantage policy MA06.025s has been updated with changes to coverage, medical necessity criteria, and billing codes for presumptive and definitive drug testing in substance abuse and pain management treatments. This affects both reimbursement positions and coding guidelines for drug testing procedures.
Medium impact
MA08.173a, Tislelizumab-jsgr (Tevimbra®)
Independence Blue Cross·Effective Jun 1, 2026
MA08.173a updates medical necessity criteria for Tislelizumab-jsgr (Tevimbra®), a PD-1 inhibitor immunotherapy. This policy change affects prior authorization and coverage requirements for this pharmaceutical agent under Medicare Advantage plans effective June 1, 2026.
Medium impact
MA08.183a, Zenocutuzumab-zbco (Bizengri®)
Independence Blue Cross·Effective Jun 1, 2026
MA08.183a updates medical necessity criteria for Zenocutuzumab-zbco (Bizengri®), a new pharmacy agent. This is a recent policy change (1 month old) affecting Medicare Advantage coverage and prior authorization requirements for this medication. Billing teams must implement new medical necessity documentation and authorization workflows to ensure claim approval.
Medium impact
MA08.184a, Cosibelimab-ipdl (Unloxcyt™)
Independence Blue Cross·Effective Jun 1, 2026
MA08.184a establishes medical necessity criteria for Cosibelimab-ipdl (Unloxcyt™), a newly covered pharmacy agent effective June 1, 2026. The billing team must implement prior authorization requirements and ensure claims include documentation supporting medical necessity criteria outlined in this policy.

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Archive by year

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MA11.060h, Catheter Ablation of Cardiac Arrhythmias

MA11.012f, Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aorto-Iliac Aneurysms, and Infrarenal Aortic Aneurysms

MA07.048a, Instrument-Based Vision Screening

MA06.013e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test

MA11.052f, Ablation of Lung Tumors

MA11.115, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis

MA07.006d, Fecal Microbiota Transplantation (FMT)

MA11.055g, Procedures for the Treatment of Gastroesophageal Reflux Disease (GERD)

MA07.026r, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

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

MA08.016h, Treatment of Pulmonary Artery Hypertension with Intravenous, Subcutaneous, and Inhaled Pharmacologic Agents

MA11.097f, Percutaneous Image-Guided Lumbar Decompression (PILD) for Spinal Stenosis

MA08.144c, Tezepelumab-ekko (Tezspire®)

MA08.176a, Tarlatamab-dlle (Imdelltra® for intravenous use

MA00.047t, Musculoskeletal Services

MA08.170b, Toripalimab-tpzi (Loqtorzi®)

MA08.047n, Pemetrexed (Pemfexy™)

MA08.011i, Erythropoiesis Stimulating Agents (ESAs)

MA08.159d, Mirvetuximab soravtansine-gynx (Elahere®)

MA05.046k, Wheelchair Options and Accessories

MA06.001g, Apheresis Therapy

MA06.025s, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

MA08.173a, Tislelizumab-jsgr (Tevimbra®)

MA08.183a, Zenocutuzumab-zbco (Bizengri®)

MA08.184a, Cosibelimab-ipdl (Unloxcyt™)