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
Effective date
Jul 9, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued policy on MA06.013e covering serodiagnosis testing for Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test. The policy provides coverage guidance for this specific diagnostic test under Medicare Advantage plans. Billing teams must verify current coverage criteria, prior authorization requirements, and applicable billing codes for this test to ensure proper claim submission and reimbursement.
Action Required
By July 9, 2025: Billing and clinical staff must review the complete MA06.013e policy text to identify: (1) specific CPT or HCPCS codes for Prometheus IBD sgi Diagnostic testing, (2) prior authorization requirements, and (3) medical necessity criteria. Update billing system rules and encounter workflows to reflect any new requirements. Contact the policy source at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx to obtain the full policy details, as the summary provided does not list specific billing codes. Ensure all claims for IBD serodiagnosis testing submitted on or after July 9, 2025 comply with the reissued policy requirements to avoid denials.