CommercialPrior AuthHigh impact
06.02.52am, eviCore Lab Management (Independence)
Independence Blue Cross·PA · Genetics, Oncology, Hematology +7 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Effective January 1, 2026, Independence Blue Cross is updating its eviCore Lab Management policy with new procedure codes, revised clinical guidelines, and substantive medical necessity criteria changes. Six codes (0602U, 0611U, 0612U, 0613U, 81354, 81524) now require pre-service AND prepayment reviews; seven codes (87183, 87494, 87627, 0600U, 0605U, 0607U, 0608U) require prepayment reviews only; and 10 PLA codes are being deleted from coverage.
Action Required
By December 15, 2025: Billing team must update billing software and claim submission protocols to implement the following changes effective 01/01/2026: (1) Add CPT/HCPCS codes 0602U, 0611U, 0612U, 0613U, 81354, and 81524 to require BOTH pre-service authorization AND prepayment reviews through eviCore before claim submission; (2) Add CPT/HCPCS codes 87183, 87494, 87627, 0600U, 0605U, 0607U, and 0608U to require prepayment reviews only (no pre-service requirement); (3) Remove CPT/HCPCS codes 0033U, 0131U, 0132U, 0135U, 0361U, 0508U, 0509U, 0544U, 0550U, and 0551U from billable/coverable code lists and deny claims for these codes as non-covered; (4) Flag codes 0365U, 0524U, 0537U, 0565U, 0569U, 0596U, 83015, and 83018 for review to confirm substantive criteria changes are integrated into authorizations; (5) Update provider workflows and encounter documentation to reflect new pre-service review requirements for the 6 newly added codes; (6) Notify providers and lab partners of these changes. Failure to implement pre-service reviews for new codes will result in claim denials, and continued billing of deleted codes will result in automatic denials. Verify all claims against updated Attachments A and B in the policy.