​​Changes to medical policy on ostomy supplies

November 4, 2022

​Effective December 5, 2022, Independence Blue Cross and Independence Administrators will update their medical policy on ostomy supplies for both Commercial and Medicare Advantage members.

For Commercial members

The following criteria will be added to this policy as Medically Necessary:

  • The individual requires collection or drainage of post-operative related fluids (e.g., anastomotic leak, abscess).

Face-to-face requirement language will be added for the following HCPCS code:

  • A5121 Skin barrier; solid, 6x6 or equivalent, each

For Medicare Advantage members

The following criteria will be added to this policy as Not Covered:

  • Ostomy supplies used for conditions other than for colostomies, ileostomies, or urinary ostomies

In accordance with Medicare, face-to-face requirement language will be added per CMS Final Rule for the following HCPCS code:

  • A5121 Skin barrier; solid, 6x6 or equivalent, each

For more information, view the Commercial and Medicare Advantage policy notifications, which were published on November 4, 2022.