All PlansCoverageHigh impact
Codes That Do Not Meet Payment Determination Criteria
HMSA·Genetics, Pathology·Medical Policy
We identified it
Oct 4, 2026
Summary
HMSA has added 24 laboratory/genetic testing codes (0640U, 0641U, 0642U, 0643U, 0646U, 0647U, 0649U, 0650U, 0633U, 0634U, 0635U, 0636U, 0637U, 0638U, 0639U, 0652U, 0653U, 0654U, 0655U, 0656U, 0657U, 0658U, 0659U) to its list of codes that do not meet payment determination criteria, meaning these codes will not be eligible for reimbursement effective immediately. The billing team must identify and reject or rework any pending or future claims using these codes.
Action Required
Immediately: Billing team must update billing software and claims processing system to flag and deny all claims submitted with codes 0640U, 0641U, 0642U, 0643U, 0646U, 0647U, 0649U, 0650U, 0633U, 0634U, 0635U, 0636U, 0637U, 0638U, 0639U, 0652U, 0653U, 0654U, 0655U, 0656U, 0657U, 0658U, and 0659U to HMSA plans. Audit all pending claims and work queue for these codes and reject before submission. Notify providers and laboratory partners that these codes are non-payable under HMSA plans and provide alternative codes if available. Update internal policy documentation and billing guidelines. Failure to implement this change will result in claim denials, increased rework, and revenue loss.