Medicare AdvantageBilling CodesHigh impact
MA05.060h, External Infusion Pumps
Independence Blue Cross·Oncology, Endocrinology, Pain Management +3 more·Pharmacy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross updated MA05.060h to add new HCPCS codes for external infusion pumps and fluorouracil injections, effective 10/01/2026. Four codes were added (A4228, E0788, J9191, J9192) and one code was deleted (J9190). Additionally, eight HCPCS equipment codes now require Face-to-Face Encounter and Written Order Prior to Delivery documentation per Medicare Final Rule.
Action Required
By September 15, 2026: (1) Billing team must update billing system to recognize new HCPCS codes A4228, E0788, J9191, and J9192 as covered under MA05.060h external infusion pump policy. (2) Remove J9190 (old fluorouracil code) from billing templates and system configurations to prevent claim denials. (3) For codes E0424, E0431, E0433, E0434, E0439, E1390, E1391, and E1392, implement mandatory Face-to-Face Encounter and Written Order Prior to Delivery (WOPD) documentation requirements in the billing software—claims will be denied without proof of F2F encounter and written order. (4) Update prior authorization workflows to include WOPD verification for the eight affected equipment codes. (5) Alert providers and practice staff to document F2F encounters and obtain written orders before dispensing these durable medical equipment items. (6) Audit claims from 10/01/2026 forward to ensure compliance; non-compliant claims will result in denials from Independence Blue Cross Medicare Advantage plans.