Medicare AdvantageBilling CodesMedium impact
MA00.003ah, Preventive Care Services
Independence Blue Cross·Family Medicine, Internal Medicine, General Practice +5 more·Medical Policy
Effective date
Jul 1, 2026
We identified it
Jul 2, 2026
Summary
Independence Blue Cross Medicare Advantage updated policy MA00.003ah effective 07/01/2026 with three key changes: (1) added CPT codes 87494 and 0455U for combined chlamydia/gonorrhea STI screening, (2) clarified AAA ultrasound coverage (CPT 76706) requires specific diagnosis codes Z13.6 and Z84.89, and (3) removed the lifetime frequency limit for Medicare Diabetes Prevention Program. Billing teams must update coding systems and encounter documentation to reflect these preventive care modifications.
Action Required
By 06/30/2026: (1) Billing team must update billing software to recognize CPT 87494 and 0455U as covered preventive codes for STI screening claims for Medicare Advantage members. (2) Update AAA ultrasound billing logic to require both ICD-10 diagnosis codes Z13.6 AND Z84.89 reported with CPT 76706 to receive preventive coverage; claims missing either code will process as non-preventive. (3) Remove frequency restrictions in system for Medicare Diabetes Prevention Program (MDPP) to allow unlimited enrollments per member lifetime instead of one-time limit. (4) Update provider encounter forms and clinical templates to reflect unlimited MDPP eligibility. (5) Communicate changes to providers to ensure correct diagnosis code selection on orders. Failure to implement may result in claim denials or improper reimbursement for preventive services.