CommercialBilling CodesMedium impact
00.03.07at, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·PA·Medical Policy
Effective date
Jul 1, 2026
We identified it
Aug 6, 2026
Summary
Independence Blue Cross updated laboratory services policy (version 00.03.07au, effective 07/01/2026) with CPT code changes affecting HMO/HMO-POS capitated laboratory networks. CPT code 87638 was added to the covered capitation list, while four codes (0029U, 0032U, 0423U, 0577U) were terminated, and two codes (0034U, 0598U) underwent narrative revisions. Billing teams must verify whether affected procedures are performed in-house or at capitated sites to ensure proper claim routing and reimbursement.
Action Required
By 06/30/2026: Billing team must update laboratory service coding lists in billing software to reflect CPT/HCPCS changes. (1) ADD CPT 87638 to the list of codes eligible for payment at PCP-designated capitated laboratory sites; (2) REMOVE CPT codes 0029U, 0032U, 0423U, 0577U from coverage—do not bill these codes for HMO/HMO-POS members effective 07/01/2026; (3) REVIEW code narratives for 0034U and 0598U to understand revised coverage criteria and update internal documentation requirements. Providers ordering laboratory services must use the PCP's designated capitated site for covered codes. Front-end staff should verify member plan type (HMO/HMO-POS vs. other) before processing laboratory requisitions. Failure to comply will result in claim denials for out-of-network laboratory services or payment refusal for terminated codes.