All Insurance Policy Changes (Page 1154)

Continuing from page 1153. 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
11.14.29h, Spinal Discectomy (Independence Administrators)
Independence Blue Cross·Effective Apr 30, 2025
Independence Administrators has reissued their spinal discectomy medical policy effective April 30, 2025. This is a commercial policy update that may contain changes to coverage criteria, prior authorization requirements, or billing guidelines for spinal discectomy procedures.
Medium impact
11.14.02s, Trigger Point Injections
Independence Blue Cross·Effective Apr 30, 2025
Independence Blue Cross has reissued their policy 11.14.02s covering Trigger Point Injections under their pharmacy category. This is a commercial plan policy update that will become effective April 30, 2025.
Medium impact
07.07.01q, Routine Foot Care for Certain Medical Conditions
Independence Blue Cross·Effective Apr 16, 2025
The routine foot care policy for certain medical conditions has been reissued with an effective date of April 16, 2025. This is a reissue of an existing policy rather than a new policy change, likely involving minor updates or clarifications to coverage criteria for foot care services in patients with specific medical conditions.
Medium impact
00.01.45, Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances
Independence Blue Cross·Effective Apr 16, 2025
Policy 00.01.45 was reissued on 04/16/2025 regarding IV fluid administration for medical treatment and pharmaceutical preparation. Without access to the full policy text content, the specific changes, billing code impacts, and coverage modifications cannot be determined. The billing team must obtain and review the complete policy document to identify affected CPT/HCPCS codes, prior authorization requirements, and documentation standards.
Medium impact
00.10.43f, Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents
Independence Blue Cross·Effective Apr 16, 2025
This is a reissued commercial policy regarding reimbursement for drug and biologic agent administration, effective April 16, 2025. The policy content details are not provided in the summary, requiring review of the full policy document for specific changes.
Medium impact
11.14.03h, Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators)
Independence Blue Cross·Effective Apr 16, 2025
Independence Administrators has reissued policy 11.14.03h regarding meniscal allograft transplantation and meniscal implants, effective April 16, 2025. The billing team must review the full policy text to identify specific coverage, billing code, or prior authorization changes for these orthopedic procedures and update workflows accordingly.
Medium impact
03.00.11c, Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional
Independence Blue Cross·Effective Apr 16, 2025
This policy reissue addresses the proper use of CPT Modifier 77, which indicates a repeat procedure or service performed by a different physician or qualified healthcare professional than the original provider. The billing team must ensure this modifier is appended correctly to avoid claim denials and ensure accurate reimbursement when repeat procedures are performed by alternate providers.
Medium impact
11.14.06j, Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)
Independence Blue Cross·Effective Apr 16, 2025
Independence Administrators has reissued policy 11.14.06j regarding coverage of Autologous Chondrocyte Implantation (ACI) and other cell-based treatments for focal articular cartilage lesions, effective April 16, 2025. The billing team must review the full policy text to identify any changes to coverage criteria, prior authorization requirements, or billing code updates that may affect claim submission and reimbursement for these procedures.
Medium impact
03.00.31g, Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)
Independence Blue Cross·Effective Apr 16, 2025
Policy 03.00.31g provides guidance on the correct use of surgical modifiers 54, 55, and 56 for split or shared surgical services. This reissue (effective 04/16/2025) clarifies modifier application rules to ensure accurate billing when multiple providers participate in a single surgical procedure or when surgical care is divided between preoperative, intraoperative, and postoperative phases.
Medium impact
03.00.02c, Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
Independence Blue Cross·Effective Apr 16, 2025
This policy reissue (effective 04/16/2025) addresses the proper use of Modifier 76 for repeat procedures or services performed by the same physician or qualified health care professional. The billing team must ensure accurate application of this modifier to avoid claim denials and compliance issues.
Medium impact
05.00.38m, Negative Pressure Wound Therapy Systems
Independence Blue Cross·Effective Apr 2, 2025
The Negative Pressure Wound Therapy Systems medical policy has been reissued and will become effective April 2, 2025. This is a policy update that affects coverage and billing requirements for negative pressure wound therapy devices and related services.
Medium impact
08.02.18, Elranatamab-bcmm (Elrexfio™)
Independence Blue Cross·Effective Apr 2, 2025
Insurance policy for Elranatamab-bcmm (Elrexfio™), a pharmacy medication, has been updated and reissued. This is a very recent pharmacy policy change that may affect coverage or billing requirements for this specialized medication.
Medium impact
08.00.43f, Enfortumab vedotin-ejfv (Padcev®)
Independence Blue Cross·Effective Apr 2, 2025
Insurance policy 08.00.43f for Enfortumab vedotin-ejfv (Padcev®) has been reissued with updates effective April 2, 2025. This is a pharmacy-related policy change that will impact billing and coverage for this cancer medication.
Medium impact
05.00.71c, Standing Frames
Independence Blue Cross·Effective Apr 2, 2025
The Standing Frames medical policy (05.00.71c) has been reissued for commercial plans, effective April 2, 2025. This is a policy reissue rather than new content, but billing teams should review for any changes to coverage criteria or billing requirements for standing frame equipment.
Medium impact
05.00.59p, Lower Limb Prostheses
Independence Blue Cross·Effective Apr 2, 2025
Policy 05.00.59p for Lower Limb Prostheses has been reissued and will become effective April 2, 2025. This is a commercial policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for lower limb prosthetic devices.
Medium impact
05.00.56l, Hospital Beds and Accessories
Independence Blue Cross·Effective Apr 2, 2025
This is a commercial insurance policy reissue for Hospital Beds and Accessories (policy 05.00.56l) that will take effect April 2, 2025. The reissue was posted April 4, 2025, indicating updated coverage criteria or billing requirements for hospital bed equipment and related accessories.
Medium impact
05.00.37i, Compression Garments
Independence Blue Cross·Effective Apr 2, 2025
The Compression Garments policy (05.00.37i) has been reissued for Commercial plans, effective April 2, 2025. This is a policy update that affects billing and coverage for compression garments under commercial insurance plans.
High impact
11.00.09g, Solid Organ Transplantation and Procurement Cost of Organs and Tissues
Independence Blue Cross·Effective Apr 2, 2025
Policy 11.00.09g regarding Solid Organ Transplantation and Procurement Cost of Organs and Tissues was reissued effective 04/02/2025. Without access to the full policy text content, specific billing impacts cannot be determined. The billing team must review the complete policy document to identify changes to coverage, billing codes, prior authorization requirements, or documentation standards for transplant-related services.
Medium impact
07.07.02o, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions
Independence Blue Cross·Effective Apr 2, 2025
Policy 07.07.02o regarding Ultraviolet Light Therapy for dermatological conditions was reissued effective April 2, 2025. Without access to the full policy text content, the specific changes (coverage criteria, prior authorization requirements, billing code updates, or documentation changes) cannot be determined. Billing team must review the complete policy document to identify specific impacts.
Medium impact
05.00.58o, Home Oxygen Therapy
Independence Blue Cross·Effective Apr 2, 2025
The Home Oxygen Therapy policy (05.00.58o) has been reissued for commercial plans with an effective date of April 2, 2025. This is a policy reissuance rather than new content, but billing teams should verify current coverage criteria and billing requirements for home oxygen therapy services.
Medium impact
05.00.81a, Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)
Independence Blue Cross·Effective Apr 2, 2025
Policy 05.00.81a regarding Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound) was reissued effective April 2, 2025. The billing team must review the full policy text to identify specific coverage, billing code, and prior authorization requirements for osteogenic stimulator procedures and devices.
Medium impact
11.11.03d, Cryosurgical Ablation of the Prostate Gland
Independence Blue Cross·Effective Apr 2, 2025
The policy for Cryosurgical Ablation of the Prostate Gland (11.11.03d) has been reissued and will take effect April 2, 2025. This is an updated commercial policy that may contain changes to coverage criteria, billing requirements, or documentation standards for prostate cryosurgery procedures.
Medium impact
06.02.04d, Fetal Fibronectin Enzyme (fFN) Immunoassay
Independence Blue Cross·Effective Apr 2, 2025
Independence Blue Cross has reissued policy 06.02.04d regarding Fetal Fibronectin Enzyme (fFN) Immunoassay testing with an effective date of April 2, 2025. This is a policy reissuance for commercial plans, though specific changes are not detailed in the summary provided.
Low impact
08.01.22d, Alemtuzumab (Lemtrada®)
Independence Blue Cross·Effective Apr 2, 2025
A reissue of the Alemtuzumab (Lemtrada®) pharmacy policy has been posted for commercial plans. This appears to be a routine policy reissuance with no indication of substantive changes to coverage or billing requirements.
Low impact
08.00.64h, Natalizumab (Tysabri®) and Related Biosimilars
Independence Blue Cross·Effective Apr 2, 2025
The Natalizumab (Tysabri®) and Related Biosimilars pharmacy policy has been reissued with updates effective April 2, 2025. This policy governs coverage and authorization requirements for this specialty multiple sclerosis medication and its biosimilar alternatives.

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11.14.29h, Spinal Discectomy (Independence Administrators)

11.14.02s, Trigger Point Injections

07.07.01q, Routine Foot Care for Certain Medical Conditions

00.01.45, Intravenous (IV) Administration of Fluids as a Treatment of a Medical Condition or for the Preparation of Pharmaceuticals, Biologics, and other Substances

00.10.43f, Reimbursement for the Administration of Drugs, Substances, and/or Biologic Agents

11.14.03h, Meniscal Allograft Transplantation and Meniscal Implants (Independence Administrators)

03.00.11c, Modifier 77: Repeat Procedure or Service by Another Physician or Other Qualified Health Care Professional

11.14.06j, Autologous Chondrocyte Implantation (ACI) and Other Cell-based Treatments of Focal Articular Cartilage Lesions (Independence Administrators)

03.00.31g, Modifiers for Split or Shared Surgical Services (Modifiers 54, 55, and 56)

03.00.02c, Modifier 76: Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

05.00.38m, Negative Pressure Wound Therapy Systems

08.02.18, Elranatamab-bcmm (Elrexfio™)

08.00.43f, Enfortumab vedotin-ejfv (Padcev®)

05.00.71c, Standing Frames

05.00.59p, Lower Limb Prostheses

05.00.56l, Hospital Beds and Accessories

05.00.37i, Compression Garments

11.00.09g, Solid Organ Transplantation and Procurement Cost of Organs and Tissues

07.07.02o, Ultraviolet Light Therapy for the Treatment of Dermatological Conditions

05.00.58o, Home Oxygen Therapy

05.00.81a, Osteogenic Stimulators (non-invasive, invasive/semi-invasive, electrical and ultrasound)

11.11.03d, Cryosurgical Ablation of the Prostate Gland

06.02.04d, Fetal Fibronectin Enzyme (fFN) Immunoassay

08.01.22d, Alemtuzumab (Lemtrada®)

08.00.64h, Natalizumab (Tysabri®) and Related Biosimilars