All Insurance Policy Changes (Page 1169)

Continuing from page 1168. 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
05.00.21ai, Durable Medical Equipment (DME) and Consumable Medical Supplies
Independence Blue Cross·Effective Nov 10, 2025
Policy 05.00.21ai regarding Durable Medical Equipment (DME) and Consumable Medical Supplies has been updated with medical coding and general guideline changes. This is a recent policy (1 month old) effective November 10, 2025, and the billing team must review the full policy document to identify specific coding updates and coverage adjustments that may affect DME and supply claim submissions.
Medium impact
00.01.52y, Bundled Procedure Codes
Independence Blue Cross·Effective Dec 31, 2025
Independence Blue Cross has issued a policy update regarding bundled procedure codes that will change coverage and/or reimbursement positions. This policy change was notified on 10/01/2025 and will become effective on 12/31/2025.
Medium impact
00.10.03m, Reimbursement for Outpatient Emergency Department Visits
Independence Blue Cross·Effective Nov 1, 2025
This policy update affects reimbursement for outpatient emergency department visits under commercial insurance plans. The change involves coverage positions, medical coding updates, and general guidelines that will impact how ED visits are billed and reimbursed.
Medium impact
10/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products
Independence Blue Cross·Effective Oct 1, 2025
A quarterly update to CPT and HCPCS code coverage determinations for commercial insurance products has been posted. This appears to be routine quarterly maintenance of billing codes and coverage policies that may affect billing procedures.
Medium impact
08.00.26ae, Botulinum Toxin Agents
Independence Blue Cross·Effective Oct 1, 2025
Independence Blue Cross has updated their medical policy for Botulinum Toxin Agents (Policy 08.00.26ae). This fresh policy update affects commercial plans and will take effect October 1, 2025, impacting billing and coverage criteria for botulinum toxin treatments.
Medium impact
08.00.34w, Intravenous Infliximab and Related Biosimilars
Independence Blue Cross·Effective Oct 1, 2025
Policy 08.00.34w regarding Intravenous Infliximab and Related Biosimilars has been updated for commercial plans. The policy was effective October 1, 2025 but was posted and removed on the same day (November 17, 2025), suggesting this may be a temporary update or correction to the original policy.
Medium impact
06.02.06s, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)
Independence Blue Cross·Effective Nov 26, 2025
Independence Administrators reissued their policy on genetic testing for BRCA1 and BRCA2 mutations effective 11/26/2025. This is a recent policy update that may contain new coverage criteria, prior authorization requirements, or billing guidance for hereditary breast cancer genetic testing. The billing team must review the full policy text to identify specific code changes, coverage updates, and any new documentation or authorization requirements.
Low impact
07.00.20g, Routine Costs Associated with Qualifying Clinical Trials
Independence Blue Cross·Effective Nov 26, 2025
IBX Commercial has reissued policy 07.00.20g regarding routine costs associated with qualifying clinical trials, effective November 26, 2025. This is a policy reissuance with no apparent changes to existing coverage guidelines for clinical trial-related billing.
Medium impact
12.05.01j, Outpatient Diabetes Education and Self-Management Training
Independence Blue Cross·Effective Nov 26, 2025
Insurance policy 12.05.01j covering Outpatient Diabetes Education and Self-Management Training has been reissued with updates effective November 26, 2025. This is a commercial plan policy update that may affect coverage criteria or billing requirements for diabetes education services.
Medium 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 Nov 26, 2025
This is a reissued policy regarding services paid above capitation rates for HMO and HMO-POS primary care providers. The policy has been updated with a future effective date of November 26, 2025, but only summary information is available without specific details about what changed.
Low impact
08.01.26d, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])
Independence Blue Cross·Effective Nov 26, 2025
This policy reissue (effective 11/26/2025) addresses coverage and clinical criteria for enzyme replacement therapy using elapegademase-lvlr (Revcovi) for patients with adenosine deaminase severe combined immune deficiency (ADA-SCID). The billing team must ensure claims for this rare genetic disorder therapy comply with the updated policy requirements, including any prior authorization mandates and documentation standards specific to this specialized treatment.
Medium impact
08.01.18i, Vedolizumab (Entyvio®) for Injection for Intravenous Use
Independence Blue Cross·Effective Nov 26, 2025
This is a reissue of the Vedolizumab (Entyvio®) policy effective 11/26/2025. Without access to the full policy text content, specific changes cannot be determined. The billing team must obtain and review the complete policy document to identify whether coverage criteria, prior authorization requirements, billing codes, or reimbursement terms have changed compared to the previous version.
Low impact
08.01.85b, Tebentafusp-tebn (Kimmtrak®)
Independence Blue Cross·Effective Nov 26, 2025
Commercial insurance policy for Tebentafusp-tebn (Kimmtrak®), a pharmacy benefit drug, has been reissued with an effective date of November 26, 2025. This appears to be an updated policy for this specialized oncology medication used to treat uveal melanoma.
Medium impact
08.00.70e, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)
Independence Blue Cross·Effective Nov 26, 2025
This is a reissue of the Enzyme Replacement Therapy policy for Mucopolysaccharidosis covering drugs like Aldurazyme, Elaprase, Vimizim, Naglazyme, and Mepsevii. The policy has been updated but specific changes are not detailed in the summary provided.
Medium impact
06.02.51d, Testing Serum Vitamin D Levels
Independence Blue Cross·Effective Nov 26, 2025
A commercial insurance policy regarding Testing Serum Vitamin D Levels has been reissued and will be effective November 26, 2025. This appears to be an updated version of an existing policy, though specific changes are not detailed in the summary provided.
Medium impact
00.03.10f, Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product
Independence Blue Cross·Effective Nov 26, 2025
This is a reissued policy for obstetrical ultrasounds specific to HMO and HMO-POS products. The policy has been updated with a new effective date of November 26, 2025, but no specific details about what changed are provided in the summary.
Medium impact
08.01.95c, Risankizumab-rzaa (Skyrizi®) for Intravenous Use
Independence Blue Cross·Effective Nov 26, 2025
Policy 08.01.95c for Risankizumab-rzaa (Skyrizi®) intravenous use has been reissued with an effective date of November 26, 2025. This is a commercial policy update that may affect coverage, billing, or prior authorization requirements for this specialty medication used to treat conditions like psoriasis and Crohn's disease.
High impact
08.00.66w, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Independence Blue Cross·Effective Nov 26, 2025
Policy 08.00.66w for Bevacizumab (Avastin®) and related biosimilars for oncologic use has been reissued effective November 26, 2025. This is a recent policy update that may contain changes to coverage criteria, prior authorization requirements, or billing guidelines for bevacizumab and its biosimilar alternatives in cancer treatment. Billing teams must review the full policy text to identify specific coverage changes, documentation requirements, and any new prior authorization workflows.
Medium impact
00.10.39q, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Independence Blue Cross·Effective Nov 26, 2025
Policy 00.10.39q addresses billing for professional office-based services performed in outpatient settings located within a facility or on a facility campus. This recent reissue (effective 11/26/2025) clarifies billing rules and requirements for services delivered in these dual-location scenarios to ensure accurate claim submission and reimbursement.
Medium impact
05.00.44t, Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices
Independence Blue Cross·Effective Nov 26, 2025
This is a reissued policy for Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices that becomes effective November 26, 2025. The policy update affects commercial insurance plans, but specific changes are not detailed in the summary provided.
Medium impact
06.02.54c, Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing
Independence Blue Cross·Effective Nov 26, 2025
Policy 06.02.54c regarding Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing was reissued effective 11/26/2025. Without access to the full policy text content, the specific billing impacts, coverage changes, or prior authorization requirements cannot be determined. The billing team must immediately obtain and review the complete policy document to identify any changes from the previous version.
Medium impact
00.03.03i, Outpatient Short-Term Rehabilitation Services Included in Capitation
Independence Blue Cross·Effective Nov 26, 2025
Policy 00.03.03i clarifies that outpatient short-term rehabilitation services are included in capitation payments for commercial plans, effective 11/26/2025. This is a reissue of existing policy with no substantive changes noted.
Medium impact
08.00.72l, Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )
Independence Blue Cross·Effective Nov 26, 2025
This policy reissue (effective 11/26/2025) addresses coverage and billing requirements for three enzyme replacement therapies: Alglucosidase alfa (Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme®), and Cipaglucosidase alfa-atga (Pombiliti™). The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and billing code changes that may impact claims processing for these specialty pharmaceutical products.
Medium impact
05.00.79l, Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems
Independence Blue Cross·Effective Nov 26, 2025
Independence Blue Cross has reissued policy 05.00.79l covering Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems, effective November 26, 2025. This is a commercial policy update that may affect coverage criteria, billing requirements, or documentation standards for diabetes management devices.
Low impact
07.03.27, Pain Management of Peripheral Nerves by Injection
Independence Blue Cross·Effective Nov 26, 2025
A commercial insurance policy regarding pain management of peripheral nerves by injection has been reissued and updated. This appears to be a policy refresh or restatement rather than substantive changes to coverage or billing requirements.

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Archive by year

2023 2024 2025 2026

05.00.21ai, Durable Medical Equipment (DME) and Consumable Medical Supplies

00.01.52y, Bundled Procedure Codes

00.10.03m, Reimbursement for Outpatient Emergency Department Visits

10/01/2025 CPT & HCPCS Quarterly Code Update Coverage Determinations for Commercial Products

08.00.26ae, Botulinum Toxin Agents

08.00.34w, Intravenous Infliximab and Related Biosimilars

06.02.06s, Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations (Independence Administrators)

07.00.20g, Routine Costs Associated with Qualifying Clinical Trials

12.05.01j, Outpatient Diabetes Education and Self-Management Training

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

08.01.26d, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])

08.01.18i, Vedolizumab (Entyvio®) for Injection for Intravenous Use

08.01.85b, Tebentafusp-tebn (Kimmtrak®)

08.00.70e, Enzyme Replacement Therapy for Mucopolysaccharidosis (e.g., Aldurazyme®, Elaprase®, Vimizim®, Naglazyme®, Mepsevii™, etc.)

06.02.51d, Testing Serum Vitamin D Levels

00.03.10f, Obstetrical Ultrasounds for Members Enrolled in a Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Product

08.01.95c, Risankizumab-rzaa (Skyrizi®) for Intravenous Use

08.00.66w, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use

00.10.39q, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

05.00.44t, Repair and Replacement of Durable Medical Equipment (DME) and Prosthetic Devices

06.02.54c, Cobalamin (Vitamin B12), Folic Acid, and Homocysteine Testing

00.03.03i, Outpatient Short-Term Rehabilitation Services Included in Capitation

08.00.72l, Alglucosidase alfa (e.g., Lumizyme®), Avalglucosidase alfa-ngpt (Nexviazyme® ), Cipaglucosidase alfa-atga (Pombiliti™ )

05.00.79l, Insulin Pumps and Long-Term Interstitial Continuous Glucose Monitoring Systems

07.03.27, Pain Management of Peripheral Nerves by Injection