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​​Policies effective January 1, 2023

January 5, 2023

​The following Independence Blue Cross and Independence Administrators policies went into effect on January 1, 2023:

Commercial policies:

  • 00.10.41k: Telemedicine
  • 05.00.69c: Home-Use Light Box Therapy for the Treatment of Seasonal Affective Disorder (SAD)
  • 05.00.80c: Cranial Electrotherapy Stimulation
  • 06.02.30g: Pharmacogenetic Testing to Determine Drug Sensitivity
  • 06.02.44p: Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
  • 06.02.55a: Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
  • 07.03.07h: Medical Evaluation and Management for Attention-Deficit Hyperactivity Disorder (ADHD)
  • 07.03.22e: Transcranial Magnetic Stimulation
  • 08.01.37b: Maintenance Treatment of Opioid or Alcohol Dependence Disorder
  • 08.01.80a: Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
  • 11.15.16r: Vagus Nerve Stimulation (VNS)
  • 11.15.20q: Deep Brain Stimulation (DBS)
  • 12.01.01bg: Experimental/Investigational
  • 12.04.04b: Acute Care Facility Inpatient Transfers
  • 14.00.01: Electroconvulsive therapy (ECT)
  • 14.00.02: Psychological Testing
  • 14.00.03: Applied Behavioral Analysis (ABA) for the Treatment of Autism Spectrum Disorder (ASD)

Medicare Advantage policies:

  • MA00.005af: Experimental/Investigational
  • MA05.022a: Home-Use Light Box Therapy for the Treatment of Seasonal Affective Disorder (SAD)
  • MA05.066c: Cranial Electrotherapy Stimulation
  • MA06.025p: Presumptive and Definitive Drug Testing in Substance Abuse and Pain Management Treatments
  • MA06.029a: Therapeutic Drug Monitoring for Antidepressants, Antipsychotics, or Antiepileptics
  • MA07.035d: Transcranial Magnetic Stimulation
  • MA08.137a: Intravenous Ketamine (Ketalar®) and Intranasal Esketamine (Spravato®)
  • MA11.005e: Deep Brain Stimulation (DBS)
  • MA11.019h: Vagus Nerve Stimulation (VNS)
  • MA12.003b: Acute Care Facility Inpatient Transfers
  • MA14.001: Electroconvulsive therapy (ECT)
  • MA14.002: Psychological Testing

For more information, please refer to the Commercial and Medicare Advantage policies, which were published on January 1, 2023.

This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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