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Independence Blue CrossCommercial · Coverage · Medical Policy · Anesthesiology, Pain Management, Orthopedics +1 moreHigh impact

12.01.01bp, Experimental/Investigational Services

Act
by Mar 31, 2025
Effective date
Apr 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated its Experimental/Investigational Services policy (12.01.01bu, effective 04/01/2025) adding 9 new CPT codes, 6 new HCPCS codes, and pericapsular nerve group (PENG) block services to the non-covered experimental list, while removing/terminating 19 obsolete HCPCS codes and 3 CPT codes. Billing teams must immediately identify and deny claims for the newly listed experimental codes effective April 1, 2025.

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What to do

by Mar 31, 2025 · 7 steps
01Billing team must update the billing system to deny claims submitted with CPT codes 0535U, 0541U, 0542U, 0545U, 0546U, 0547U, 0548U, 0550U, 0551U and HCPCS codes C8004, C8005, G0183, G0566, Q4360, S4024 as experimental/investigational (non-covered).
02Immediately remove from system and cease billing: CPT codes 0553T, 0567T, 0568T (terminated 01/01/2025) and 19 M, Q, and other HCPCS codes (terminated 04/01/2025).
03Replace S4988 with E0201 in all billing records and system mappings.
04Update denial reason codes to reference Policy 12.01.01bu for all experimental service denials.
05Notify providers and front desk that unlisted code 64999 for PENG Block is now non-covered.
06Add C1739 to system with revised narrative per Attachment A.
07Train billing staff that claims for these codes will be automatically denied without prior authorization consideration, resulting in patient responsibility and no reimbursement.

Codes mentioned

C8004C8005G0183G0566Q4360S4024C9784C9785M0220M0221M0222M0223M0240M0241M0243M0244M0245M0246M0247Q0220Q0221Q0222Q0240Q0243Q0244Q0245Q0247S4988E0201C173964999

Original notice

12.01.01bp, Experimental/Investigational Services
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
MA00.005ao, Experimental/Investigational ServicesMediumEffective Apr 1, 2025 · Medical Policy00.01.25bs, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative ServicesHighEffective Apr 1, 2025 · Network12.01.01bv, Experimental/Investigational ServicesMediumEffective Oct 1, 2026 · Medical Policy11.03.02x, Bariatric SurgeryHighEffective Mar 17, 2026 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesAnesthesiologyPain ManagementOrthopedicsGeneral SurgeryCode C8004Code C8005Code G0183Code G0566Code Q4360Code S4024Code C9784Code C9785Code M0220Code M0221Code M0222Code M0223Code M0240Code M0241Code M0243Code M0244Code M0245Code M0246Code M0247Code Q0220Code Q0221Code Q0222Code Q0240Code Q0243Code Q0244Code Q0245Code Q0247Code S4988Code E0201Code C1739Code 64999

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