Medicare AdvantageCoverageMedium impact
MA11.077i, Prophylactic Mastectomy, Oophorectomy/Salpingo-Oophorectomy, and Hysterectomy
Independence Blue Cross·OB-GYN, General Surgery·Medical Policy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
Policy MA11.077i regarding prophylactic mastectomy, oophorectomy/salpingo-oophorectomy, and hysterectomy has been reissued effective 04/01/2026. The billing team must review the full policy text to identify specific coverage criteria, prior authorization requirements, and any billing code updates to ensure compliant claim submission for these preventive surgical procedures.
Action Required
By March 15, 2026: Billing team must obtain and review the complete policy text from https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=04&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma11-077i-prophylactic-mastectomy-oophore to identify specific CPT/HCPCS codes, prior authorization requirements, and medical necessity criteria. Update billing system rules, encounter templates, and provider education materials to reflect any coverage changes. Coordinate with OB/GYN and general surgery providers to ensure documentation meets new requirements. Failure to implement changes before the 04/01/2026 effective date may result in claim denials for non-compliant submissions.