Below is a listing of the policy activity that we have posted to our website
from February 26 ? March 25, 2014.
New policies
The following policies have been newly developed to communicate coverage
and/or reimbursement positions,
reporting requirements, and other processes and procedures for doing business
with IBC.
Policy #
Title
Notification date
Effective date
00.01.56
National Correct Coding Initiative (NCCI) Modifier Indicator 0
(Zero) Procedure Code Pairs
February 12, 2014
May 13, 2014
08.01.10
Octreotide acetate (Sandostatin® LAR Depot)
December 4, 2013
March 4, 2014
Updated policies
The following policies have been reviewed and updated to communicate current
coverage and/or reimbursement
positions, reporting requirements, and other processes and procedures for doing
business with IBC.
Policy #
Title
Type of policy change
Notification date
Effective date
00.10.37a
Humanitarian Use Devices (HUD) and the Humanitarian Device Exemption (HDE)
Process
Description, Guidelines, or
Informational Update
N/A
March 12, 2014
05.00.09g
Electrical Bone Growth Stimulation and Low-Intensity Ultrasound Accelerated
Fracture Healing System
Medical Necessity Criteria;
Medical Codes; General
Description, Guidelines, or
Informational Update
February 14, 2014
March 14, 2014
05.00.11e
Therapeutic Shoes and Orthopedic Shoes
Description, Guidelines, or
Informational Update
N/A
March 12, 2014
05.00.15n
Nebulizers
Medical Coding
N/A
March 12, 2014
05.00.16d
Blood Pressure Devices for Home Use
Description, Guidelines, or
Informational Update
N/A
March 12, 2014
05.00.29h
Automatic External and Wearable Cardioverter
Defibrillators
Description, Guidelines, or
Informational Update
N/A
March 12, 2014
05.00.35c
Foot Orthotics and Other Podiatric Appliances
Coverage and/or Reimbursement Position; Medical Coding
February 14, 2014
March 12, 2014
08.00.50l
Rituximab (Rituxan®)
Medical Necessity Criteria;
Medical Coding
March 5, 2014
June 3, 2014
08.00.62e
Abatacept (Orencia®) for Injection for Intravenous Use
Description, Guidelines, or
Informational Update; Medical
Necessity Criteria
March 5, 2014
June 3, 2014
08.00.73e
Bortezomib (Velcade®)
Medical Necessity Criteria;
Medical Coding
January 2, 2014
April 2, 2014
08.00.74g
Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists
(e.g., ranibizumab [Lucentis®], pegaptanib sodium
[Macugen®], aflibercept [Eylea®])
Coverage and/or Reimbursement Position; Medical Coding; General Description,
Guidelines,
or Informational Update
January 2, 2014
April 2, 2014
08.00.78l
Self-Administered Drugs
Coverage and/or Reimbursement Position; Medical Coding
N/A
February 26, 2014
08.00.81c
Bendamustine Hydrochloride (Treanda®)
Medical Necessity Criteria
February 12, 2014
May 13, 2014
08.00.85d
Tocilizumab (Actemra®) for Intravenous Infusion
Description, Guidelines, or
Informational Update; Medical
Necessity Criteria
March 5, 2014
June 3, 2014
09.00.10p
Brachytherapy
Coverage and/or Reimbursement
Position; Medical Coding;
General Description, Guidelines,
or Informational Update
December 19, 2013
March 19, 2014
09.00.17j
Intensity Modulated Radiation Therapy (IMRT)
Coverage and/or Reimbursement
Position; Medical Coding;
General Description, Guidelines,
or Informational Update
January 3, 2014
April 2, 2014
09.00.46l
High-Technology Radiology
Services
Coverage and/or Reimbursement Position; Medical Codes
January 31, 2014
(notification revised on
February 12, 2014)
May 1, 2014
09.00.49e
Proton Beam Radiation
Therapy
Medical Necessity Criteria;
Medical Coding
January 2, 2014
April 2, 2014
11.02.06j
Catheter Ablation of Cardiac
Arrhythmias
Coverage and/or Reimbursement
Position; Medical Necessity
Criteria; Medical Codes; General
Description, Guidelines, or
Informational Update
February 26, 2014
March 26, 2014
11.08.25j
Scar Revision
Coverage and/or Reimbursement
Position; Medical Coding
January 2, 2014
April 2, 2014
11.16.01g
Septoplasty, Rhinoplasty, and Septorhinoplasty
Medical Necessity Criteria;
General Description, Guidelines,
or Informational Update
December 19, 2013
March 19, 2014
Reissued policies
The following policies have been reviewed, and no substantive changes were
made.
Policy #
Title
Reissue effective date
00.01.44e
Never Events and Preventable Adverse Events
March 5, 2014
05.00.71b
Standing Frames
March 19, 2014
07.02.07g
Ambulatory, Real-Time Cardiac Surveillance System
March 5, 2014
07.03.08d
Neuropsychological Evaluation/Testing
March 19, 2014
07.03.22
Repetitive Transcranial Magnetic Stimulation (rTMS)
March 19, 2014
08.00.93a
C1 Esterase Inhibitors (Human): Cinryze® and
Berinert®
March 19, 2014
11.15.13c
Lysis of Epidural Adhesions
March 19, 2014
11.15.24
Migraine Deactivation Surgery
March 19, 2014
Coding updates
The following policies have been reviewed and updated to add new and revised
medical codes (e.g., ICD-9 and
ICD-10 diagnosis codes; CPT® and HCPCS codes; revenue codes)
and/or remove terminated medical codes.
Policy #
Title
Effective date
00.03.03e
Outpatient Short-Term Rehabilitation Services Included in Capitation
January 1, 2014 (published on March 7, 2014)
03.00.07n
Modifer 51: Multiple Procedures
January 1, 2014
(published on March 24, 2014)
03.00.29h
Modifier 51 Exempt
March 7, 2014
(published on March 24, 2014)
08.01.04g
Preventive Immunization
January 2, 2014
(published on March 10, 2014)
08.09.11s
Medicare Part B vs. Part D Crossover Drugs
January 2, 2014
(published on March 7, 2014)
11.00.10p
Multiple Surgical Reduction Guidelines
January 1, 2014
(published on March 21, 2014)
To view policy activity, go to our Medical Policy Portal and select
Accept and Go to Medical Policy Online. You can also view policy
activity using the NaviNet® web portal by selecting
Reference Tools from the Plan Transactions menu, then Medical
Policy. Be sure to check back often, as the site is updated frequently.
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