​​Notification of policies going into effect January 1, 2023

November 1, 2022

​The following Independence Blue Cross and Independence Administrators policies went into notification on November 1, 2022, and will become effective 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 policy notifications published on November 1, 2022. ​