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00.03.07au, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Effective date
Oct 1, 2026
Identified
Oct 2, 2026
Summary
Independence Blue Cross updated policy 00.03.07au effective 10/01/2026 to add 39 new laboratory CPT codes (0660U-0698U) to the capitated laboratory program for HMO/HMO-POS members, terminate CPT code 0585U, and revise narratives for codes 0247U, 0575U, and 0591U. These codes must now be billed to the member's PCP-designated capitated laboratory site, not to non-capitated facilities, or claims will be denied.
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What to do
Action · 9 steps
01DEADLINE: By October 1, 2026 - Billing team and EMR/practice management system administrators must take the following actions.
02Update billing software system to recognize CPT codes 0660U through 0698U as capitated laboratory codes requiring routing ONLY to the member's PCP-designated capitated laboratory site for HMO/HMO-POS plans.
03Remove or terminate CPT code 0585U from all billing templates, encounter forms, and system configurations - claims submitted with this code will be denied.
04Review and update code narratives in the system for CPT codes 0247U, 0575U, and 0591U to reflect revised descriptions per Attachment A1.
05Add a system validation rule to reject or flag any claim for codes 0660U-0698U submitted to non-capitated laboratory facilities for HMO/HMO-POS members.
06Notify all providers, laboratory staff, and front desk personnel of the new capitated code list and routing requirements via training or bulletin.
07Update laboratory requisition templates to include the newly capitated codes.
08Educate billers that failure to route these codes to designated capitated sites will result in claim denials.
09Verify all changes are in place before October 1, 2026, as claims submitted after this date with incorrect routing will be denied.
Original notice
00.03.07au, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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