All Insurance Policy Changes (Page 1158)

Continuing from page 1157. 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
08.01.75d, Margetuximab-cmkb (Margenza)
Independence Blue Cross·Effective May 28, 2025
Independence Blue Cross has reissued their medical policy for Margetuximab-cmkb (Margenza), an oncology medication, with an effective date of May 28, 2025. This is a pharmacy policy update that will affect billing and coverage for this specific cancer treatment drug.
Medium impact
11.08.15ac, Reconstructive Breast Surgery and Post-Mastectomy Prostheses
Independence Blue Cross·Effective May 28, 2025
This is a reissue of policy 11.08.15ac covering Reconstructive Breast Surgery and Post-Mastectomy Prostheses for commercial plans. The policy was reposted with an effective date of 05/28/2025, but no specific changes are detailed in the summary provided.
Low impact
08.02.04, Velmanase alfa (Lamzede)
Independence Blue Cross·Effective May 28, 2025
The policy for Velmanase alfa (Lamzede) is being reissued with an effective date of May 28, 2025. This appears to be a scheduled policy update for commercial plans, though specific changes are not detailed in the summary provided.
Medium impact
08.02.31, Crovalimab-akkz (Piasky)
Independence Blue Cross·Effective May 28, 2025
A new policy for Crovalimab-akkz (Piasky), a pharmacy benefit, will be reissued with an effective date of May 28, 2025. This appears to be a scheduled policy update for a specific medication, though detailed coverage or billing requirements are not specified in the summary provided.
Low impact
08.02.08a, Rozanolixizumab-noli (Rystiggo)
Independence Blue Cross·Effective May 28, 2025
A policy for Rozanolixizumab-noli (Rystiggo), a specialty pharmacy medication, has been reissued with an effective date of May 28, 2025. This appears to be an administrative reissue of an existing commercial insurance policy rather than a substantive change to coverage or billing requirements.
Medium impact
08.00.51l, Enzyme Replacement for the Treatment of Gaucher's Disease
Independence Blue Cross·Effective May 28, 2025
Policy 08.00.51l regarding Enzyme Replacement for the Treatment of Gaucher's Disease has been reissued effective 05/28/2025. Without access to the full policy text content, the specific coverage changes, billing code requirements, or prior authorization updates cannot be determined. The billing team must review the complete policy document to identify coverage criteria, approved enzymes, authorization requirements, and any changes from the previous version.
Medium impact
11.14.28e, Spinal Laminectomy (Independence Administrators)
Independence Blue Cross·Effective May 14, 2025
Independence Administrators has reissued their spinal laminectomy policy 11.14.28e with an effective date of May 14, 2025. This is a policy reissue rather than a new policy change, suggesting potential updates to coverage criteria or administrative requirements for spinal laminectomy procedures.
Medium impact
11.15.01y, Spinal Cord Ganglion and Dorsal Root Ganglion Stimulation (Independence Administrators)
Independence Blue Cross·Effective May 14, 2025
Independence Administrators has reissued policy 11.15.01y regarding coverage and billing for Spinal Cord Ganglion and Dorsal Root Ganglion Stimulation procedures, effective May 14, 2025. The billing team must review this reissued policy to identify any changes to prior authorization requirements, covered codes, medical necessity criteria, or reimbursement rates that may affect claim submission and processing.
Medium impact
11.14.19p, Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)
Independence Blue Cross·Effective May 14, 2025
Independence Administrators has reissued their policy 11.14.19p covering Artificial Intervertebral Cervical Disc Insertion procedures. This is a policy reissue that became effective May 14, 2025, updating the medical policy for commercial plans regarding cervical disc replacement procedures.
Medium impact
11.15.09r, Denervation of the Spinal Nerves for Chronic Pain (Independence Administrators)
Independence Blue Cross·Effective May 14, 2025
Independence Administrators has reissued their policy on denervation of spinal nerves for chronic pain treatment. This is a commercial policy reissue that will become effective May 14, 2025, likely involving updates to coverage criteria or billing requirements for spinal nerve denervation procedures.
Medium impact
11.03.05e, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)
Independence Blue Cross·Effective May 14, 2025
This is a reissued policy (effective 05/14/2025) on frenectomy, frenotomy, or frenoplasty procedures for ankyloglossia (tongue-tie). Without access to the full policy text content, specific coverage criteria, billing code requirements, prior authorization mandates, or changes from the previous version cannot be determined. The medical billing team must review the complete policy document to identify coverage parameters, medical necessity requirements, and any billing workflow impacts.
Low impact
02.02.01h, Hospice Care
Independence Blue Cross·Effective May 14, 2025
This is a hospice care policy reissue for commercial plans with an effective date of May 14, 2025. The policy content is limited to summary information only, indicating this is a routine policy update or republication rather than substantive changes.
Medium impact
02.01.01g, Home Health Care Services
Independence Blue Cross·Effective May 1, 2025
The Home Health Care Services policy (02.01.01g) has been reissued for commercial plans effective May 1, 2025. This is a policy restatement rather than a substantive change, but billing teams should review the updated policy details to ensure compliance with any clarified requirements.
Medium impact
08.01.79f, Dostarlimab-gxly (Jemperli)
Independence Blue Cross·Effective May 19, 2025
Policy 08.01.79f for Dostarlimab-gxly (Jemperli) has been updated with new medical necessity criteria effective May 19, 2025. The billing team must implement these updated criteria to ensure claims meet coverage requirements and avoid denials for this pharmaceutical agent.
Medium impact
08.00.21a, Givosiran (Givlaari) and Panhematin (Hemin)
Independence Blue Cross·Effective May 19, 2025
Updated medical policy for Givosiran (Givlaari) and Panhematin (Hemin) with changes to medical necessity criteria, coding requirements, and general guidelines. This affects billing and coverage determination for these specialized medications used in treating acute hepatic porphyria.
Medium impact
12.01.01bp, Experimental/Investigational Services
Independence Blue Cross·Effective Apr 1, 2025
IBC/Independence Blue Cross has updated their medical policy for Experimental/Investigational Services with coding changes. This appears to be a medical coding update that will affect how experimental or investigational procedures and services are billed and processed.
Medium impact
08.02.30, Imetelstat (Rytelo™)
Independence Blue Cross·Effective May 19, 2025
IBX has implemented a new commercial policy for Imetelstat (Rytelo™), a pharmacy benefit medication. This appears to establish coverage criteria and billing guidelines for this newly approved drug therapy.
Medium impact
08.02.37, Eladocagene exuparvovec-tneq (Kebilidi™)
Independence Blue Cross·Effective Nov 13, 2024
This is a new pharmacy policy for Eladocagene exuparvovec-tneq (Kebilidi™), a gene therapy treatment effective November 13, 2024. The billing team must establish coverage, prior authorization, and billing procedures for this newly covered drug. Specific coverage criteria, billing codes, and authorization requirements should be reviewed in the full policy document.
Medium impact
06.02.44r, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
Independence Blue Cross·Effective Jun 25, 2025
Independence Blue Cross has reissued policy 06.02.44r regarding presumptive and definitive drug testing in substance abuse and pain management treatments. This is a commercial policy update with an effective date of June 25, 2025.
Medium impact
06.02.55b, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
Independence Blue Cross·Effective Jun 25, 2025
Insurance policy 06.02.55b regarding Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics has been reissued with updates effective June 25, 2025. This affects commercial insurance plans and may impact billing procedures for drug monitoring services in psychiatric and neurological care.
Medium impact
09.00.17q, Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)
Independence Blue Cross·Effective Jun 11, 2025
Independence Administrators has reissued their policy 09.00.17q for Intensity-Modulated Radiation Therapy (IMRT) effective June 11, 2025. This is a commercial policy update that may contain changes to coverage criteria, prior authorization requirements, or billing guidelines for IMRT procedures.
Medium impact
09.00.10z, Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy
Independence Blue Cross·Effective Jun 11, 2025
This is a reissued policy on Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy, effective June 11, 2025. The policy document title and reissue date are provided, but the specific policy content changes are not detailed in the information supplied. The billing team must obtain the full policy text to identify specific coverage criteria, billing code requirements, or prior authorization mandates.
Medium impact
11.15.23l, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Independence Administrators)
Independence Blue Cross·Effective Jun 11, 2025
Independence Administrators has reissued their policy on epidural, paravertebral facet, and sacroiliac joint injections for spinal pain management. This appears to be a policy reissuance with an effective date of June 11, 2025, though specific content changes are not detailed in the summary provided.
Low impact
08.01.14e, Radium Ra 223 dichloride (Xofigo®) Injection (Independence Administrators)
Independence Blue Cross·Effective Jun 11, 2025
Independence Administrators has reissued their policy for Radium Ra 223 dichloride (Xofigo®) injection coverage. This is a reissue of an existing pharmacy policy with no indication of substantive changes to coverage or billing requirements.
Medium impact
09.00.48h, Radioembolization for Primary and Metastatic Tumors of the Liver
Independence Blue Cross·Effective Jun 11, 2025
Policy 09.00.48h regarding radioembolization for primary and metastatic liver tumors has been reissued effective June 11, 2025. This is a recent policy update that may contain revised coverage criteria, medical necessity requirements, or prior authorization guidelines for radioembolization procedures. The billing team must review the full policy text to identify specific billing code changes, coverage modifications, or authorization requirements that differ from previous guidance.

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Archive by year

2023 2024 2025 2026

08.01.75d, Margetuximab-cmkb (Margenza)

11.08.15ac, Reconstructive Breast Surgery and Post-Mastectomy Prostheses

08.02.04, Velmanase alfa (Lamzede)

08.02.31, Crovalimab-akkz (Piasky)

08.02.08a, Rozanolixizumab-noli (Rystiggo)

08.00.51l, Enzyme Replacement for the Treatment of Gaucher's Disease

11.14.28e, Spinal Laminectomy (Independence Administrators)

11.15.01y, Spinal Cord Ganglion and Dorsal Root Ganglion Stimulation (Independence Administrators)

11.14.19p, Artificial Intervertebral Cervical Disc Insertion (Independence Administrators)

11.15.09r, Denervation of the Spinal Nerves for Chronic Pain (Independence Administrators)

11.03.05e, Frenectomy, Frenotomy, or Frenoplasty for Ankyloglossia (Tongue-Tie)

02.02.01h, Hospice Care

02.01.01g, Home Health Care Services

08.01.79f, Dostarlimab-gxly (Jemperli)

08.00.21a, Givosiran (Givlaari) and Panhematin (Hemin)

12.01.01bp, Experimental/Investigational Services

08.02.30, Imetelstat (Rytelo™)

08.02.37, Eladocagene exuparvovec-tneq (Kebilidi™)

06.02.44r, Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments

06.02.55b, Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics

09.00.17q, Intensity-Modulated Radiation Therapy (IMRT) (Independence Administrators)

09.00.10z, Brachytherapy and Accelerated Whole Breast Irradiation using Three-Dimensional Conformation Radiation Therapy

11.15.23l, Epidural, Paravertebral Facet, and Sacroiliac Joint Injections for Spinal Pain Management (Independence Administrators)

08.01.14e, Radium Ra 223 dichloride (Xofigo®) Injection (Independence Administrators)

09.00.48h, Radioembolization for Primary and Metastatic Tumors of the Liver