Who is affected by this change?

This affects Independence Blue Cross OB-GYN, General Surgery, Oncology providers on Commercial plans.

When does this change take effect?

This change is effective Apr 30, 2025.

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CommercialCoverageMedium impact

11.08.19r, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy

Independence Blue Cross·OB-GYN, General Surgery, Oncology·Medical Policy

Effective date

Apr 30, 2025

We identified it

Jun 19, 2026

Days to comply

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Summary

This is a reissue of policy 11.08.19r covering prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures for commercial plans. The policy has been reissued with an effective date of April 30, 2025, but specific changes are not detailed in the summary provided.

Action Required

Action needed

By April 30, 2025: Review the full policy document at the provided URL to understand specific coverage changes for prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy procedures. Update billing procedures and prior authorization requirements as specified in the complete policy for commercial plans.

Related policy hubs

Independence Blue Cross policies OB-GYN General Surgery Oncology