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Independence Blue CrossCommercial · Billing Codes · Medical Policy · PA · Genetics, Oncology, Pathology +2 moreHigh impact

06.02.52aj, eviCore Lab Management (Independence)

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

Summary

Independence Blue Cross added 13 new procedure codes (0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, G0567) to the eviCore Lab Management program effective 04/01/2025, and revised the narrative for code 0288U. All these codes now require prepayment review through eviCore, and certain codes may require pre-service review. Billing teams must update their systems to route these codes for eviCore review before claim submission.

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What to do

by Mar 31, 2025 · 4 steps
01Billing team must update billing software and claims processing system to route CPT codes 0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, and HCPCS code G0567 to eviCore for prepayment review.
02Update encounter forms and provider documentation templates to alert staff that these lab tests require eviCore authorization.
03Verify which of these new codes require pre-service review by consulting Attachment A of the full policy.
04Review the revised narrative for code 0288U and update any internal guidelines.
If missed: Failure to route claims through eviCore will result in claim denials or delays for Independence Blue Cross members.

Codes mentioned

G0567

Original notice

06.02.52aj, eviCore Lab Management (Independence)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA00.003ac, Preventive Care ServicesMediumEffective Apr 1, 2025 · Medical PolicyMA06.034q, eviCore Lab ManagementMediumEffective 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 · Network00.06.02au, Preventive Care ServicesHighEffective Apr 1, 2025 · Medical PolicyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPA policy changesGeneticsOncologyPathologyInternal MedicineGeneral PracticeCode G0567

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06.02.52aj, eviCore Lab (Independence) - PA Commercial