Effective April 10, 2023, Independence Blue Cross and Independence Administrators will update their medical policies on insertion of implantable infusion pumps for Commercial members and implantable infusion pumps for Medicare Advantage members.
For Commercial members, the medically necessary criteria will be updated to this policy specifically for the treatment of chemotherapy for cancer with the American Joint Committee on Cancer (AJCC) staging system .
For Medicare Advantage members, the title of this policy will be updated to implantable infusion pumps. The previous title was implantable and external infusion pumps. The scope of this policy will be revised to continue the company's position for implantable infusion pumps for Medicare Advantage members.
The following CPT® codes will be added to this policy: 36260, 36261, 36262, 36563, 36576, 36578, 36583, 36590, 61215, 62350, 62351, 62355, 62360, 62361, 62362, 62365, 62367, 62368, 62369, 62370, 95990, 95991, 96522, 96523 .
The following HCPCS codes will be added to this policy: J0475, J0476, J2270, J2274, J2278.
The following HCPCS codes will be removed from this policy: A4222, A4223, A4224, A4225, A4602, A9274, E0776, E0779, E0780, E0781, E0784, E0787, E0791, E1399, K0455, K0552, K0601, K0602, K0603, K0604, K0605, J0133, J0285, J0287, J0288, J0289, J0895, J1170, J1250, J1265, J1325, J1455, J1457, J1551, J1555, J1558, J1559, J1561, J1569, J1570, J1575, J1817, J1960, J2175, J2180, J2260, J2270, J2274, J2278, J3010, J3285, J7340, J9000, J9039, J9040, J9065, J9100, J9190, J9200, J9360, J9370, S0155
For more information, please view the following notifications that were published on March 10, 2023:
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