CommercialCoverageMedium impact
12.01.01bo, Experimental/Investigational Services
Independence Blue Cross·Medical Policy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 12.01.01bo regarding Experimental/Investigational Services has been updated effective January 1, 2025. This is a coverage and reimbursement policy change that may affect how experimental or investigational procedures and services are billed and reimbursed. The billing team must review the full policy text to understand specific coverage determinations and any prior authorization requirements that may apply.
Action Required
By February 28, 2025: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=02&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-12-01-01bo to identify specific CPT/HCPCS codes affected by this experimental/investigational services coverage change. Update billing software and encounter templates to reflect any new prior authorization requirements, coverage restrictions, or billing code changes. Communicate updates to all providers and clinical staff. Ensure claims submitted on or after January 1, 2025 comply with the new guidelines to avoid denials.