Medicare AdvantageBilling CodesMedium impact
MA00.026ab, Bundled Procedure Codes
Independence Blue Cross·OB-GYN, Family Medicine, Internal Medicine +1 more·Medical Policy
Effective date
Oct 1, 2026
We identified it
Jul 2, 2026
Summary
Independence Blue Cross Medicare Advantage is revising its bundled procedure code policy effective 10/01/2026. CPT code 99459 (pelvic exam during E/M service) is now classified as not eligible for separate reimbursement and has been added to Attachment B. Additionally, HCPCS codes G9037 and G9038 have been terminated and removed from Attachment C.
Action Required
By 10/01/2026: Billing team must update billing software and claim submission rules to deny separate reimbursement for CPT 99459 when billed with E/M services for the same member on the same date. Remove CPT 99459 from any standalone billing workflows. Additionally, remove HCPCS codes G9037 and G9038 from all claim submission systems and encounter forms, as these codes are no longer valid for billing. Verify that all claim edits prevent billing of CPT 99459 as a standalone charge or separately with E/M visits. Train billing staff and providers that pelvic exams performed during E/M visits cannot be billed separately and members cannot be balance-billed for this service. Update internal documentation and billing guidelines to reflect these changes.