Medicare AdvantageCoverageHigh impact
MA00.005as, Experimental/Investigational Services
Independence Blue Cross·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated its policy on experimental and investigational services, affecting both coverage decisions and medical coding requirements. This change impacts how providers determine coverage eligibility and submit claims for services that may be considered experimental or investigational.
Action Required
Before April 1, 2026: Billing team must review and update procedures for identifying experimental/investigational services. Update billing system to flag potentially experimental procedures for coverage verification. Train staff on new coding requirements and coverage determination processes. Establish workflow to verify coverage before providing services that may be considered experimental to avoid claim denials.