CommercialCoverageHigh impact
12.01.01bt, Experimental/Investigational Services
Independence Blue Cross·Bariatric Surgery, Urology, Nephrology +5 more·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 12.01.01bt (now superseded by 12.01.01bu) to reclassify experimental/investigational services effective 04/01/2026. The update adds 12 new HCPCS codes and 2 new CPT codes to the non-covered experimental list, removes 8 CPT codes and 1 HCPCS code that are now covered or addressed in separate policies, and adds unlisted code services (autologous tissue harvesting, hematopoietic cells, and remote monitoring systems) as experimental/investigational. Billing teams must immediately update systems to reflect these code changes to prevent claim denials.
Action Required
By April 1, 2026: Billing team must update all billing software and claim submission systems to reflect code changes. ADDITIONS (mark as non-covered/experimental): CPT codes 0614U, 0615U; HCPCS codes A4479, A8005, A8006, C1743, C8010, G0680, L2221, M0224, Q0224; unlisted codes 20999 and E1399 for specified services. REMOVALS (update coverage status): Remove CPT codes 43290, 43291, 43889, 0813T from this policy's experimental list (now covered under bariatric surgery policy); remove CPT codes 0935T (now covered under renal denervation policy); remove CPT codes 51721, 55881, 55882 (now covered under BPH policy); remove HCPCS code C9756 (now eligible). Front desk staff must alert providers that claims for added codes will be denied without prior authorization or medical necessity documentation. Claims for removed codes should route to appropriate specialty policies. Update encounter templates and pre-authorization workflows. Failure to implement changes will result in claim denials for experimental services.