All Insurance Policy Changes (Page 1149)

Continuing from page 1148. 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
02.03.00a, Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care
Independence Blue Cross·Effective Jan 6, 2025
Policy 02.03.00a regarding Skilled Nursing Facility (SNF) Skilled and Subacute Levels of Care was updated effective January 6, 2025. This is a general description, guidelines, or informational update. Without access to the full policy text content, the specific changes cannot be determined from the provided information.
Medium impact
08.00.17k, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
Independence Blue Cross·Effective Jan 1, 2025
Policy 08.00.17k updates medical necessity criteria for Total Parenteral Nutrition (TPN), Intradialytic Parenteral Nutrition (IDPN), and Intraperitoneal Parenteral Nutrition (IPN) effective January 1, 2025. This is a recent policy change (1 month old) that modifies coverage requirements for parenteral nutrition therapies. The billing team must review and implement the new medical necessity criteria to ensure compliant claim submission.
Medium impact
08.01.35i, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)
Independence Blue Cross·Effective Jan 1, 2025
This policy establishes medical necessity criteria for Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®), a specialty pharmaceutical used in acute lymphoblastic leukemia (ALL) treatment. The billing team must now verify that claims meet the new medical necessity requirements before submission to avoid denials.
Medium impact
08.01.69d, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)
Independence Blue Cross·Effective Jan 1, 2025
Policy 08.01.69d updates medical necessity criteria for Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza™) effective January 1, 2025. The billing team must review and implement the new medical necessity requirements to ensure claims meet current coverage guidelines and avoid denials.
Medium impact
08.02.06b, Tofersen (Qalsody®)
Independence Blue Cross·Effective Jan 1, 2025
Policy 08.02.06b addresses coverage and reimbursement for Tofersen (Qalsody®), a pharmacy treatment. This is a recent policy change effective January 1, 2025, that impacts how this medication is billed and reimbursed under commercial plans. The billing team must review the full policy details to determine specific prior authorization, coverage criteria, or reimbursement adjustments.
Low impact
11.06.07e, Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome
Independence Blue Cross·Effective Jan 1, 2025
Policy 11.06.07e regarding Ovarian and Internal Iliac Vein Embolization for Pelvic Congestion Syndrome has been updated with changes to general description, guidelines, or informational content. This is a general informational update that may affect coverage criteria or documentation requirements for this specialized gynecological procedure.
Medium impact
07.02.21q, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring
Independence Blue Cross·Effective Jan 1, 2025
This is a medical coding update for Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring services. The policy change affects billing procedures for cardiac monitoring devices and services effective January 1, 2025.
Medium impact
11.02.17i, Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions
Independence Blue Cross·Effective Jan 1, 2025
Policy 11.02.17i was updated effective January 1, 2025, with changes to medical necessity criteria, medical coding guidelines, and general description for endovascular stent graft repair of thoracic aortic aneurysms and nonaneurysmal lesions. The billing team must review updated medical necessity requirements and coding guidelines to ensure accurate claim submission and avoid denials.
Medium impact
08.01.34d, Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)
Independence Blue Cross·Effective Jan 1, 2025
This policy establishes coverage and medical necessity criteria for four exon-skipping drugs used to treat Duchenne Muscular Dystrophy (DMD): Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso), and Casimersen (Amondys 45). The policy defines eligibility requirements, prior authorization requirements, and reimbursement guidelines effective January 1, 2025. Billing teams must implement prior authorization workflows and ensure claims meet specified medical necessity criteria.
High impact
00.06.02at, Preventive Care Services
Independence Blue Cross·Effective Jan 1, 2025
Independence Blue Cross updated their preventive care services policy (00.06.02at) with changes to coverage, reimbursement positions, medical necessity criteria, and medical coding requirements. This affects how preventive services are billed and reimbursed for commercial plans.
Medium impact
11.00.03m, Fetal Surgery
Independence Blue Cross·Effective Jan 1, 2025
Policy 11.00.03m on Fetal Surgery has been updated effective January 1, 2025, with changes to medical necessity criteria, medical coding guidelines, and general policy descriptions. The billing team must review updated medical necessity requirements and coding guidance to ensure accurate claim submission and authorization for fetal surgical procedures.
Medium impact
06.02.52ai, eviCore Lab Management (Independence)
Independence Blue Cross·Effective Jan 1, 2025
Independence Blue Cross updated their eviCore Lab Management policy affecting coverage, medical necessity criteria, and billing codes for laboratory services. This change includes updates to reimbursement positions and general guidelines for commercial plans.
Medium impact
08.01.93e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease
Independence Blue Cross·Effective Jan 1, 2025
This policy establishes coverage and medical necessity criteria for monoclonal antibodies directed against amyloid for Alzheimer Disease treatment, effective January 1, 2025. The billing team must implement prior authorization requirements and ensure claims comply with updated medical necessity guidelines for these specialty biologics.
Medium impact
06.02.53, Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer
Independence Blue Cross·Effective Jan 27, 2025
This is a NEW policy (effective 01/27/2025) establishing coverage criteria and clinical guidelines for protein biomarkers in prostate cancer diagnosis and cancer risk assessment. The billing team must obtain the full policy details to identify specific CPT/HCPCS codes, prior authorization requirements, and documentation standards before processing claims for these services.
Medium impact
11.03.16, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis
Independence Blue Cross·Effective Jan 20, 2025
This is a NEW medical policy establishing coverage criteria for Direct Endoscopic Necrosectomy (DEN) as a treatment for pancreatic necrosis. The policy becomes effective 01/20/2025 and will require billing teams to understand coverage requirements, medical necessity documentation, and applicable billing codes for this endoscopic procedure.
Medium impact
08.02.29, Intravenous (IV) Iron Preparations
Independence Blue Cross·Effective Jan 1, 2025
This is a new medical policy (08.02.29) effective January 1, 2025, establishing coverage guidelines and billing requirements for intravenous (IV) iron preparations. The billing team must obtain the full policy details to determine specific coverage criteria, prior authorization requirements, and applicable billing codes for IV iron administration and infusion services.
Medium impact
08.02.35, Drugs, Biologics, or Gene Therapies with an Accelerated Approval
Independence Blue Cross·Effective Jan 1, 2025
This is a new policy (Policy 08.02.35) effective January 1, 2025, establishing coverage and billing guidelines for drugs, biologics, or gene therapies that have received FDA accelerated approval status. The billing team must understand how this new policy affects claim submission, prior authorization requirements, and coverage determinations for accelerated approval medications.
Medium impact
10.00.04, Medical Nutrition Therapy (MNT)/Nutrition Counseling
Independence Blue Cross·Effective Jan 1, 2025
This is a NEW policy effective 01/01/2025 for Medical Nutrition Therapy (MNT)/Nutrition Counseling. The policy establishes coverage guidelines, billing requirements, and authorization procedures for nutrition counseling services. The billing team must review the full policy details to understand coverage criteria, required prior authorization processes, applicable billing codes, and documentation requirements specific to MNT services.
Medium impact
11.03.02v, Bariatric Surgery
Independence Blue Cross·Effective Feb 24, 2025
Policy 11.03.02v regarding Bariatric Surgery has been updated with changes to coverage and/or reimbursement position, medical necessity criteria, medical coding, and general guidelines. This recent policy (effective 02/24/2025) requires the billing team to review updated medical necessity requirements and any coding changes for bariatric surgery procedures to ensure compliant claim submission.
Medium impact
05.00.83, Eye Prostheses and Scleral Cover Shell
Independence Blue Cross·Effective Feb 24, 2025
This is a new medical policy (05.00.83) effective February 24, 2025, that establishes coverage guidelines for eye prostheses and scleral cover shells. The billing team must review the full policy text to identify specific codes, coverage criteria, prior authorization requirements, and documentation standards that will apply to these claims starting on the effective date.
Medium impact
1/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products
Independence Blue Cross·Effective Jan 1, 2025
Independence Blue Cross has released their quarterly CPT and HCPCS code updates effective January 1, 2025 for commercial products. This routine quarterly update likely includes new, revised, or deleted billing codes that may affect coverage determinations and billing practices.
High impact
00.10.01al, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Independence Blue Cross·Effective Jan 1, 2025
Policy 00.10.01al defines which services provided by HMO and HMO-POS primary care providers are paid above capitation (i.e., on a fee-for-service basis rather than included in the capitated rate). This recent policy, effective 01/01/2025, clarifies billing and payment methodology for primary care services under capitated arrangements. Billing teams must understand which services bypass capitation to ensure correct claim submission and reimbursement.
Medium impact
00.03.07ao, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Effective Jan 1, 2025
This is a policy update for laboratory services specifically for members enrolled in HMO and HMO-POS products. The policy became effective January 1, 2025 but was just posted, indicating changes to how lab services are covered or billed for these specific plan types.
High impact
03.00.06ab, 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 Jan 1, 2025
This policy clarifies the requirements for appending Modifier 25 to Evaluation and Management (E/M) services billed on the same day as a procedure or other service by the same provider. Modifier 25 indicates the E/M service is significant and separately identifiable from the procedure. The billing team must ensure proper documentation and coding practices align with this guidance effective January 1, 2025.
High impact
03.00.20t, Modifiers 26 (Professional Component) and TC (Technical Component)
Independence Blue Cross·Effective Jan 1, 2025
Policy 03.00.20t addresses the use of CPT modifiers 26 (Professional Component) and TC (Technical Component) for billing purposes, effective January 1, 2025. This policy clarifies when and how these modifiers should be applied to diagnostic and procedural codes to ensure proper component-based billing and reimbursement.

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Archive by year

2023 2024 2025 2026

02.03.00a, Skilled Nursing Facility (SNF): Skilled and Subacute Levels of Care

08.00.17k, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)

08.01.35i, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)

08.01.69d, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)

08.02.06b, Tofersen (Qalsody®)

11.06.07e, Ovarian and Internal Iliac Vein Embolization as Treatment for Pelvic Congestion Syndrome

07.02.21q, Ambulatory Electrocardiography (AECG) Monitoring and Mobile Cardiac Outpatient Telemetry (MCOT) Monitoring

11.02.17i, Endovascular Stent Graft Repair of Thoracic Aortic Aneurysms and Nonaneurysmal Lesions

08.01.34d, Exon Skipping Drugs for Duchenne Muscular Dystrophy (DMD) (Eteplirsen (Exondys 51), Golodirsen (Vyondys 53), Viltolarsen (Viltepso)), Casimersen (Amondys 45)

00.06.02at, Preventive Care Services

11.00.03m, Fetal Surgery

06.02.52ai, eviCore Lab Management (Independence)

08.01.93e, Monoclonal Antibodies Directed Against Amyloid for the Treatment of Alzheimer Disease

06.02.53, Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer

11.03.16, Direct Endoscopic Necrosectomy (DEN) for the Treatment of Pancreatic Necrosis

08.02.29, Intravenous (IV) Iron Preparations

08.02.35, Drugs, Biologics, or Gene Therapies with an Accelerated Approval

10.00.04, Medical Nutrition Therapy (MNT)/Nutrition Counseling

11.03.02v, Bariatric Surgery

05.00.83, Eye Prostheses and Scleral Cover Shell

1/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products

00.10.01al, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers

00.03.07ao, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products

03.00.06ab, 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

03.00.20t, Modifiers 26 (Professional Component) and TC (Technical Component)