CommercialBilling CodesMedium impact
05.00.05t, Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes
Independence Blue Cross·Endocrinology, Internal Medicine, Family Medicine +2 more·Medical Policy
Effective date
Oct 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued Policy 05.00.05t with minor clarifications to diabetes equipment, supplies, and pharmaceuticals coverage. The most recent update (10/29/2025) adds ICD-10 code E11.A (Type 2 diabetes mellitus without complications in remission) and HCPCS code J1612 (Injection, glucagon (gvoke), 0.01 mg), while previous updates added CGM and artificial pancreas device codes (K0553, K0554, S1034, S1035, S1036) and clarified coverage limits for blood glucose test strips (A4253) and lancets (A4259) at up to 200 units per month.
Action Required
By 2025-10-29: Billing team must update system and claims processing software to recognize and process new HCPCS codes K0553, K0554, S1034, S1035, S1036, and J1612 for diabetes treatment. Update billing rules to enforce 200-unit monthly limits for blood glucose test strips (A4253) and lancets (A4259); claims exceeding this threshold require provider documentation of medical necessity in patient records. Add new ICD-10 diagnostic codes E11.A, E11.A0, E11.A1, E10.A0, and E10.A1 to billing system drop-down menus and encounter forms. Ensure A4271 (integrated lancing cartridges) is billed per 50 tests rather than per month. Train billing and verification staff on updated policy language. Flag claims missing required documentation of testing frequency for quantities exceeding 200 units per month for manual review and denial processing.