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MA06.034t, eviCore Lab Management

Independence Blue Cross·PA · Genetics, Oncology, Hematology +6 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Days to comply
—

Summary

Effective January 1, 2026, Independence Blue Cross Medicare Advantage updates the MA06.034v eviCore Lab Management policy with significant coding changes: 6 new procedure codes added to pre-service and prepayment review requirements, 7 codes added to prepayment-only review, 10 PLA codes deleted, and 47 existing clinical guidelines revised (19 substantively). Two new genetic testing guidelines for Hereditary Ataxia and Hereditary Connective Tissue/Thoracic Aortic Disease are added, requiring billing staff to update authorization workflows and code tracking immediately.

Action Required

Action needed
By December 15, 2025: Billing team must update eviCore authorization tracking and claims processing system to reflect all code changes. ADDED TO PRE-SERVICE AND PREPAYMENT REVIEWS: CPT/PLA codes 0602U, 0611U, 0612U, 0613U, 81354, 81524 — require prior authorization requests before claim submission. ADDED TO PREPAYMENT-ONLY REVIEWS: CPT/PLA codes 87183, 87494, 87627, 0600U, 0605U, 0607U, 0608U — no pre-service auth required but will be reviewed before payment. DELETED CODES: Remove CPT/PLA codes 0033U, 0131U, 0132U, 0135U, 0361U, 0508U, 0509U, 0544U, 0550U, 0551U from all authorization and coverage lists — claims for these codes may be denied as not covered. Update encounter forms, charge descriptions, and billing rules in EHR/billing software. Train providers and front desk on new pre-service authorization requirement for the 6 newly added codes. Review and implement revised clinical guidelines for Flow Cytometry, Genetic Testing by Multigene Panels, Lynch Syndrome Testing, Somatic Mutation Testing, Exome Sequencing, Genome Sequencing, and 13 other revised guidelines per eviCore's updated clinical guidelines link. Consequences: Claims submitted without required pre-service authorization will be denied; claims using deleted codes will be denied as not medically necessary or experimental.

Affected Billing Codes

81354
81524
87183
87494
87627
83015
83018
MA06.034t, eviCore Lab Management | Independence Blue Cross | PolicyChanges.app