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00.03.06g, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Serv
Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated ICD-10 diagnosis codes for Pelvic Floor Therapy services under policy 00.03.06g, effective 10/01/2025. The broad code R10.2 (abdominal pain) was replaced with five more specific subcodes (R10.20, R10.21, R10.22, R10.23, R10.24), and hand therapy diagnosis codes on Attachment A2 (S62.90XA, S62.90XB, S62.91XA, S62.91XB, S62.92XA, S62.92XB) received narrative revisions. Billing teams must update their systems to recognize only the new specific codes for claims reimbursement above capitation for HMO/HMO-POS members.
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What to do
by Sep 30, 2025 · 5 steps
01Billing team must update billing system and encounter templates to replace ICD-10 code R10.2 with the five new specific subcodes (R10.20, R10.21, R10.22, R10.23, R10.24) for Pelvic Floor Therapy claims submitted to Independence Blue Cross.
02Review the narrative revisions for hand therapy codes (S62.90XA, S62.90XB, S62.91XA, S62.91XB, S62.92XA, S62.92XB) on Attachment A2 and update any internal documentation or coding guidelines accordingly.
03Effective 10/01/2025, claims using the old R10.2 code will not qualify for above-capitation reimbursement for HMO/HMO-POS members and will be denied.
04Coordinate with PT/OT providers to ensure they update their documentation and coding practices.
05Verify all affected diagnosis codes are accurate in the billing system before the effective date.
Codes mentioned
R10.2R10.20R10.21R10.22R10.23R10.24S62.90XAS62.90XBS62.91XAS62.91XBS62.92XAS62.92XB
Original notice
00.03.06g, Physical Medicine and Rehabilitation Services Eligible for Reimbursement Above Capitation to Physical and Occupational Therapy (PT/OT) Providers for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Serv
medpolicy.ibx.com · Always check the source before changing claims.
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