All Insurance Policy Changes (Page 1127)

MA00.010au, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services

This policy establishes PPO Network Rules for specialty services including Durable Medical Equipment (DME), Laboratory, Radiology, and Physical Medicine & Rehabilitative Services for Medicare Advantage plans effective 10/01/2025. The billing team must review the full policy text to identify specific network requirements, prior authorization mandates, and in-network vs. out-of-network billing rules that may affect claims processing for these service categories.