Medicare AdvantageCoverageMedium impact
MA06.013e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Independence Blue Cross·Gastroenterology, Internal Medicine, Pharmacy·Pharmacy
Effective date
Jun 10, 2026
We identified it
Jun 19, 2026
Summary
Policy MA06.013e regarding serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test was reissued effective 06/10/2026. This is a recent policy update (1 month old) that billing teams must review for any changes to coverage criteria, prior authorization requirements, or billing code updates for IBD serological testing under Medicare Advantage plans.
Action Required
By 06/10/2026: Billing team must obtain and review the complete full policy text from the provided URL to identify: (1) any specific CPT or HCPCS codes for IBD serodiagnosis testing that require updates in the billing system; (2) prior authorization requirements for Prometheus® IBD sgi Diagnostic™ Test; (3) coverage criteria and any documentation requirements. Update billing software, encounter forms, and provider guidelines accordingly. Contact the payer if specific billing codes or prior auth workflows are not clearly documented in the policy. Failure to implement required changes may result in claim denials for IBD serodiagnosis testing.