CommercialCoverageMedium impact
06.02.17h, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Independence Blue Cross·PA · Gastroenterology, Internal Medicine, General Practice +1 more·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued policy 06.02.17h confirming that serodiagnosis of inflammatory bowel disease (IBD), including the Prometheus® IBD sgi Diagnostic™ Test and related serologic markers (ANCA, pANCA, ASCA, anti-OmpC, anti-CBir1), remains classified as experimental/investigational and is NOT covered. This is a reaffirmation of existing non-coverage, not a new restriction.
Action Required
Billing team: Update denial templates and claim edits to consistently deny claims for CPT codes 0164U, 83516, 83520, and 88350 when submitted for IBD serodiagnosis testing (including Prometheus® IBD sgi Diagnostic™ and related serologic marker tests). Verify that billing system rules reflect non-coverage status for all ICD-10 diagnosis codes related to IBD (K50.x, K51.x). When providers submit orders for these tests, inform them in writing that Independence Blue Cross classifies this service as experimental/investigational and will not provide reimbursement. Document all denials with reference to policy 06.02.17h to support appeal responses. No prior authorization is required—claims should be denied at submission.