Medicare AdvantageCoverageMedium impact
MA06.013e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Independence Blue Cross·NJ · Gastroenterology, Pathology, Internal Medicine·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued MA06.013e to reaffirm that serodiagnosis of inflammatory bowel disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test remain experimental/investigational and are NOT covered under Medicare Advantage plans. No new coverage criteria were added; this is a continuation of the existing non-coverage position.
Action Required
Immediately: Billing team must ensure all claims for serodiagnosis of IBD tests (CPT 0164U, 83516, 83520, 88350) submitted to Independence Blue Cross Medicare Advantage plans are flagged as non-covered services. Do NOT submit claims for Prometheus® IBD sgi Diagnostic™ or related serologic antibody testing (ANCA, pANCA, ASCA, anti-OmpC, anti-CBir1) to these plans. Verify patient eligibility under MA plans before service delivery. Educate providers that these tests are experimental/investigational per company policy and will be denied. Update billing system rules to auto-deny or require manual review before submission for these codes under Independence Blue Cross MA plans to prevent claim rejection and improve cash flow.