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00.01.25bt, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 00.01.25bt to 00.01.25bv, effective 10/01/2025, adding 39 new CPT/HCPCS codes for DME, laboratory, radiology, and physical medicine services, and revising narratives for 7 existing codes. Billing teams must verify that claims for these newly added codes comply with PPO network rules regarding eligible provider types and settings before submission.
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What to do
Action · 5 steps
01By 10/01/2025: Billing team must update billing system and claims submission software to recognize the 39 newly added CPT/HCPCS codes (A4288, E0150, E0658, E0659, L1007, L5657, L6034-L6039, 0575U-0599U) for Independence Blue Cross PPO plans.
02Review Attachments A1-A3 (DME), B1-B3 (Laboratory), and C1 (Radiology) to verify eligible provider types for each code—claims submitted by ineligible provider specialties will be denied.
03For the 7 revised code narratives (E0765, E0986, L5673, L5679, L5783, L6028, L7406), obtain and review updated policy narratives from IBX to ensure compliance with new coverage rules.
04Providers and billing staff must confirm that DME, prosthetics, orthotics, laboratory, and radiology services are being billed by appropriately contracted specialty providers and from eligible settings (office, outpatient, home for DME, independent laboratory for lab services).
05Update encounter forms and billing templates to reflect new codes.
If missed: Failure to comply with provider type and setting restrictions will result in claim denials.
Codes mentioned
A4288E0150E0658E0659L1007L5657L6034L6035L6036L6038L6039E0765E0986L5673L5679L5783L6028L7406
Original notice
00.01.25bt, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA00.010au, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesMediumEffective Oct 1, 2025 · NetworkMA05.057e, Upper-Limb ProsthesesMediumEffective Oct 1, 2025 · Medical Policy05.00.72i, Upper Limb ProsthesesHighEffective Oct 1, 2025 · Medical PolicyMA05.044u, Durable Medical Equipment (DME)MediumEffective Oct 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesPA policy changesNJ policy changesPM&R (Physical Medicine & Rehab)Physical TherapyRadiologyOrthopedicsCode A4288Code E0150Code E0658Code E0659Code L1007Code L5657Code L6034Code L6035Code L6036Code L6038Code L6039Code E0765Code E0986Code L5673Code L5679Code L5783Code L6028Code L7406