Summary
Independence Blue Cross added face-to-face encounter and written order prior authorization requirements to home oxygen therapy HCPCS codes. Code K0738 requires prior auth effective 10/28/2026 (already in effect as of analysis date). Codes E0424, E0431, E0433, E0434, E0439, E1390, E1391, E1392 had similar language added effective 04/13/2026 (past deadline). The billing team must confirm prior auth processes are in place for these codes and that claims are not submitted without authorization.
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What to do
Action · 7 steps
01REQUIREMENTS:
1. For HCPCS code K0738 (effective 10/28/2026 — already in effect): Billing team must obtain prior authorization before submitting claims for this code.
02Update claim submission processes and charge entry so that K0738 claims are routed through prior auth validation before going out.
03Claims submitted without prior auth will be denied.
042. For HCPCS codes E0424, E0431, E0433, E0434, E0439, E1390, E1391, E1392 (effective 04/13/2026 — past deadline, verify current status): Confirm that the practice is already obtaining prior authorization for these codes per Independence Blue Cross policy.
05If claims have been submitted for these codes without prior auth since 04/13/2026, watch for denials and prepare to resubmit with proper prior auth documentation.
063. Providers and front desk staff should be notified that home oxygen therapy equipment orders must include a face-to-face encounter note and written order from the treating provider before the equipment is delivered or prior auth is requested.
074. Update internal prior auth tracking to flag all nine codes (K0738 and the eight E-codes) as requiring prior auth under Independence Blue Cross Commercial plans, and monitor future claims for compliance.
Codes mentioned
K0738E0424E0431E0433E0434E0439E1390E1391E1392
Original notice
05.00.58p, Home Oxygen Therapy
medpolicy.ibx.com · Always check the source before changing claims.
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