All Insurance Policy Changes (Page 1159)

Continuing from page 1158. 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
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.
Medium impact
07.13.01k, Orthoptic/Pleoptic Training
Independence Blue Cross·Effective Jun 11, 2025
This is a reissue of the Orthoptic/Pleoptic Training medical policy for commercial plans, with an effective date of June 11, 2025. The policy content has been updated but specific details of the changes are not provided in this summary-only notification.
Medium impact
08.01.77e, Trilaciclib (Cosela™)
Independence Blue Cross·Effective Jun 11, 2025
The Trilaciclib (Cosela™) pharmacy policy has been reissued and will take effect June 11, 2025. This is a commercial insurance policy update affecting the cancer drug Trilaciclib, though specific coverage changes are not detailed in the summary.
Medium impact
08.02.03a, Etranacogene dezaparvovec-drlb (Hemgenix®)
Independence Blue Cross·Effective May 28, 2025
This is a reissue of the policy for Etranacogene dezaparvovec-drlb (Hemgenix®), a gene therapy for hemophilia B. The policy is being reposted with an effective date of May 28, 2025, indicating updated coverage or billing requirements for this specialized pharmaceutical treatment.
Low impact
08.02.24, Atidarsagene autotemcel (Lenmeldy)
Independence Blue Cross·Effective May 28, 2025
A new medical policy for Atidarsagene autotemcel (Lenmeldy) has been issued for commercial plans. This is a gene therapy treatment policy that will be reissued with an effective date of May 28, 2025.
Medium impact
08.02.14a, Casgevy™ (exagamglogene autotemcel)
Independence Blue Cross·Effective Jul 1, 2025
This is a new pharmacy policy for Casgevy™ (exagamglogene autotemcel), a gene therapy treatment, effective July 1, 2025. The policy establishes coverage criteria, medical necessity requirements, and reimbursement guidelines for this drug. Billing teams must implement prior authorization and documentation requirements for claims submitted on or after the effective date.
Medium impact
08.01.94d, Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·Effective Jun 16, 2025
This policy establishes or updates medical necessity criteria for Nivolumab and Relatlimab-rmbw (Opdualag™), a combination immunotherapy drug for intravenous use. The billing team must review updated prior authorization and coverage requirements effective immediately to ensure compliant claims submission.
Medium impact
08.01.32n, Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars
Independence Blue Cross·Effective Jun 16, 2025
Medical necessity criteria and billing codes have been updated for colony-stimulating factor medications including Ryzneuta, Rolvedon, Neulasta and biosimilars. This affects commercial plan coverage and billing requirements for these supportive care medications commonly used in cancer treatment.
Medium impact
09.00.32aj, Reimbursement for Radiopharmaceutical Agents
Independence Blue Cross·Effective Apr 1, 2025
This policy update affects reimbursement for radiopharmaceutical agents used in medical imaging and nuclear medicine procedures. The medical coding changes will impact how these specialized pharmaceutical products are billed and reimbursed for commercial insurance plans.
Medium impact
08.01.83d, Tisotumab vedotin-tftv (Tivdak®)
Independence Blue Cross·Effective Jun 16, 2025
Insurance policy for Tisotumab vedotin-tftv (Tivdak®) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects how the oncology drug will be billed and what documentation is required for coverage approval.
Medium impact
08.02.00c, Mosunetuzumab-axgb (Lunsumio™)
Independence Blue Cross·Effective Jun 16, 2025
Policy 08.02.00c updates medical necessity criteria and medical coding guidelines for Mosunetuzumab-axgb (Lunsumio™), a specialty pharmaceutical agent. The billing team must implement new medical necessity documentation requirements and coding standards effective immediately to ensure claim compliance and avoid denials.
Medium impact
11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Independence Blue Cross·Effective Jun 16, 2025
Independence Blue Cross updated their policy for Hyperthermic Intraperitoneal Chemotherapy (HIPEC) for select intra-abdominal and pelvic cancers. The policy changes include coverage position, medical necessity criteria, billing codes, and general guidelines for this specialized cancer treatment procedure.
Medium impact
08.02.01c, Mirvetuximab soravtansine-gynx (Elahere®)
Independence Blue Cross·Effective Jun 16, 2025
Policy 08.02.01c establishes or updates medical necessity criteria for Mirvetuximab soravtansine-gynx (Elahere®), a pharmacy benefit medication. The billing team must ensure claims for this drug include proper documentation of medical necessity to support coverage determinations and avoid denials.
Medium impact
07.03.23h, Autonomic Nervous System Testing
Independence Blue Cross·Effective Jun 16, 2025
Coverage and/or reimbursement position updated for Autonomic Nervous System Testing under commercial insurance plans. This policy change affects how autonomic nervous system testing procedures will be covered or reimbursed starting June 16, 2025.
Medium impact
08.00.33t, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Independence Blue Cross·Effective Jun 16, 2025
Policy 08.00.33t has been updated with changes to medical necessity criteria and medical coding for Trastuzumab (Herceptin®), related biosimilars, and Trastuzumab with Hyaluronidase-oysk (Herceptin Hylecta). The billing team must review and implement updated coding and medical necessity documentation requirements effective immediately.
Medium impact
08.00.12h, Fam-trastuzumab deruxtecan-nxki (Enhertu®)
Independence Blue Cross·Effective Jun 16, 2025
Medical necessity criteria have been updated for Fam-trastuzumab deruxtecan-nxki (Enhertu®), a HER2-directed antibody-drug conjugate used in oncology. The billing team must review updated approval requirements and documentation standards for this pharmacy benefit effective immediately.
Medium impact
08.02.36a, Zolbetuximab-clzb (Vyloy®)
Independence Blue Cross·Effective Jul 1, 2025
A new commercial policy for Zolbetuximab-clzb (Vyloy®) has been updated, effective July 1, 2025. This is a pharmacy policy change that will impact billing and coverage for this medication.
Medium impact
08.02.39a, Zanidatamab-hrii (Ziihera®)
Independence Blue Cross·Effective Jul 1, 2025
A new commercial policy for Zanidatamab-hrii (Ziihera®), a pharmacy medication, has been updated and is effective July 1, 2025. This appears to be a coverage policy for a specialized oncology drug that may affect billing and prior authorization requirements.
Medium impact
08.00.74z, 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
Updated policy for intravitreal injection of VEGF antagonists, VEGF biosimilars, and combination VEGF/Angiopoietin-2 inhibitors effective July 1, 2025. This is a commercial insurance policy update that will affect billing and coverage for these specialized eye injection procedures.
Medium impact
08.00.92aj, Coagulation Factors
Independence Blue Cross·Effective Jul 1, 2025
Commercial insurance policy 08.00.92aj regarding Coagulation Factors has been updated with an effective date of July 1, 2025. This is a very recent policy change that may affect billing and coverage for coagulation factor treatments and related procedures.
Medium impact
08.01.04ag, Routine/Non-routine Vaccines
Independence Blue Cross·Effective Jul 1, 2025
A commercial insurance policy regarding routine and non-routine vaccines has been updated, effective July 1, 2025. This is a very recent policy change that may impact vaccine billing procedures and coverage for commercial plans.
Medium impact
08.01.62f, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Independence Blue Cross·Effective Jul 1, 2025
This is a policy update for Nivolumab (Opdivo®) and Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) that became effective July 1, 2025. The policy affects commercial insurance coverage for these oncology medications, but specific details require accessing the full policy document.
Medium impact
11.09.02r, Gender-Affirming Interventions
Independence Blue Cross·Effective Jul 1, 2025
IBX has updated their medical policy 11.09.02r regarding Gender-Affirming Interventions for commercial plans. This policy change became effective July 1, 2025, and may impact coverage criteria, prior authorization requirements, or billing procedures for gender-affirming care services.
Medium impact
11.17.06u, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)
Independence Blue Cross·Effective Jul 1, 2025
Updated medical policy for surgical and minimally invasive treatments for urinary outlet obstruction due to benign prostatic hyperplasia (BPH) for commercial plans. This is a fresh policy update that may affect coverage criteria, prior authorization requirements, or billing procedures for BPH treatments.
Medium impact
11.08.20ap, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds
Independence Blue Cross·Effective Jul 1, 2025
IBX has updated their medical policy for wound care skin substitutes used in treating burns and chronic, non-healing wounds. This is a commercial policy update that becomes effective July 1, 2025.

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

07.13.01k, Orthoptic/Pleoptic Training

08.01.77e, Trilaciclib (Cosela™)

08.02.03a, Etranacogene dezaparvovec-drlb (Hemgenix®)

08.02.24, Atidarsagene autotemcel (Lenmeldy)

08.02.14a, Casgevy™ (exagamglogene autotemcel)

08.01.94d, Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use

08.01.32n, Efbemalenograstim alfa-vuxw (Ryzneuta®), Eflapegrastim-xnst (Rolvedon™), Pegfilgrastim (Neulasta®) and Related Biosimilars

09.00.32aj, Reimbursement for Radiopharmaceutical Agents

08.01.83d, Tisotumab vedotin-tftv (Tivdak®)

08.02.00c, Mosunetuzumab-axgb (Lunsumio™)

11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies

08.02.01c, Mirvetuximab soravtansine-gynx (Elahere®)

07.03.23h, Autonomic Nervous System Testing

08.00.33t, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

08.00.12h, Fam-trastuzumab deruxtecan-nxki (Enhertu®)

08.02.36a, Zolbetuximab-clzb (Vyloy®)

08.02.39a, Zanidatamab-hrii (Ziihera®)

08.00.74z, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) Inhibitors

08.00.92aj, Coagulation Factors

08.01.04ag, Routine/Non-routine Vaccines

08.01.62f, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)

11.09.02r, Gender-Affirming Interventions

11.17.06u, Surgical and Minimally Invasive Treatments for Urinary Outlet Obstruction due to Benign Prostatic Hyperplasia (BPH)

11.08.20ap, Wound Care: Skin Substitutes for the Treatment of Burns and Chronic, Non-Healing Wounds