CommercialBilling CodesHigh impact
00.03.07ar, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·PA · Pathology·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 00.03.07ar to 00.03.07au effective 01/01/2026, adding 18 new CPT/HCPCS laboratory codes to the capitated laboratory program (Attachment A1) and removing 8 terminated codes, plus adding CPT 87812 to non-capitated outpatient hospital laboratory services (Attachment B2). Billing teams must update systems to route the newly added codes to designated capitated lab sites for HMO/HMO-POS members and ensure CPT 87812 is only billed to outpatient hospital labs under specific circumstances.
Action Required
By 01/01/2026: Billing team must update billing software to route the 18 newly added CPT/HCPCS codes (87182, 87183, 87494, 87627, 0600U-0613U) to the member's designated capitated laboratory site for all HMO/HMO-POS claims. Remove the 8 terminated codes (0033U, 0131U, 0132U, 0135U, 0361U, 0544U, 0550U, 0551U) from the capitated laboratory list to prevent incorrect routing and denials. Configure billing system to restrict CPT 87812 reimbursement to outpatient hospital laboratory settings only and ensure claims include appropriate medical necessity documentation per policy requirements. Update referral forms and provider communication to reflect these code changes. Failure to implement these changes will result in incorrect claim routing, denials for newly covered codes, and improper payments for codes no longer eligible.