CommercialCoverageMedium impact
00.01.24m, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
Independence Blue Cross·OB-GYN, Pharmacy·Medical Policy
Effective date
Sep 8, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 00.01.24m to 00.01.24n, adding tocolytic infusion therapy (terbutaline sulfate) in the home setting to the list of non-covered, not medically necessary services. A new HCPCS code S9349 was added to represent home infusion therapy administrative services for tocolytic therapy. This change requires billing teams to deny claims for home tocolytic infusion therapy effective 09/08/2025.
Action Required
By September 8, 2025: Billing team must update billing system edits to deny claims for HCPCS code S9349 (home infusion therapy, tocolytic infusion therapy; administrative services) as not medically necessary under Independence Blue Cross commercial plans. Add S9349 to the non-covered services list in the billing system. Update prior authorization workflows to flag any incoming S9349 claims for automatic denial. Notify providers and home infusion vendors that tocolytic infusion therapy in the home setting is no longer covered. Failure to implement these changes will result in claims being processed as covered, leading to improper payments that may trigger compliance issues.