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Independence Blue CrossCommercial · Administrative · Medical Policy · Critical Care, General Surgery, Gastroenterology +5 moreLow impact

08.00.17k, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)

Effective date
Jan 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued policy 08.00.17k on Total Parenteral Nutrition (TPN), Intradialytic Parenteral Nutrition (IDPN), and Intraperitoneal Parenteral Nutrition (IPN) effective January 1, 2025, with no substantive coverage changes. Documentation requirements were revised to align with Noridian Local Coverage Determination 38953 (effective 01/01/2024). This is a routine reissue confirming the company's continuing position on parenteral nutrition coverage criteria.

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What to do

Action · 5 steps
01No immediate action required.
02This policy reissue contains no changes to coverage criteria, billing codes, or reimbursement rates.
03Billing team should ensure current documentation practices align with Noridian LCD 38953 requirements (malnutrition screening by qualified provider, body composition assessment methods, medical necessity criteria).
04File updated policy version 08.00.17k in compliance management system for reference, noting effective date of 01/01/2025.
05No updates to billing software, encounter forms, or prior authorization workflows are necessary.

Codes mentioned

S9364S9365

Original notice

08.00.17k, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.00.17k, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Parenteral Nutrition (IPN)MediumEffective Jan 1, 2025 · Medical PolicyMA08.008g, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN) / Intraperitoneal Nutrition (IPN)HighEffective Jan 1, 2025 · Medical PolicyMA08.008h, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN)MediumEffective Mar 16, 2026 · Medical PolicyMA08.008h, Total Parenteral Nutrition (TPN) / Intradialytic Parenteral Nutrition (IDPN)MediumEffective Mar 16, 2026 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesCritical CareGeneral SurgeryGastroenterologyNephrologyOncologyPediatricsPharmacyPalliative CareCode S9364Code S9365

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