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MA00.030am, 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 Medicare Advantage updated laboratory services policy MA00.030am, effective 10/01/2026, adding 39 new CPT codes (0660U-0698U) to the capitated laboratory services list, terminating CPT code 0585U, and revising narratives for codes 0247U, 0575U, and 0591U. HMO and HMO-POS members must obtain lab services at their PCP's designated capitated laboratory site, with limited exceptions for specialist offices and outpatient hospital laboratories.
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What to do
Action · 5 steps
01By 10/01/2026: Billing team must immediately update billing software and claims submission systems to recognize CPT codes 0660U through 0698U as capitated laboratory services covered under Independence Blue Cross Medicare Advantage HMO and HMO-POS plans.
02Remove CPT code 0585U from the covered codes list and ensure it is no longer billed.
03Update code narratives for CPT codes 0247U, 0575U, and 0591U in all internal references and billing documentation.
04Configure system rules to deny or reroute any claims for these codes submitted to non-capitated laboratory sites unless they meet criteria in Attachments B1 or B2 (specialist office or outpatient hospital exceptions).
05Providers must ensure laboratory requisition forms route to the member's designated capitated laboratory before services are rendered.
If missed: Failure to comply will result in claim denials for services performed at non-capitated sites.
Original notice
MA00.030am, 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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