Medicare AdvantageBilling CodesHigh impact
MA00.030aj, Laboratory Services for Members Enrolled in Health Maintenance Organization (HMO) or Health Maintenance Organization Point-of-Service (HMO-POS) Products
Independence Blue Cross·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated laboratory services policy MA00.030aj to MA00.030am, effective 01/01/2026, adding 18 new CPT/HCPCS codes to the capitated laboratory program and removing 8 terminated codes. One procedure code (87812) was added to non-capitated hospital laboratory services. Billing teams must update systems to route claims for new codes to designated capitated laboratory sites and verify code status before processing claims.
Action Required
By 01/01/2026: Billing team must update billing software to reflect code changes in MA00.030am. ADDED codes to capitated laboratory routing (87182, 87183, 87494, 87627, 0600U-0613U): Configure system to automatically route these claims to member's designated capitated laboratory site when billed for HMO/HMO-POS members; do NOT process as non-capitated claims. REMOVED codes from capitated list (0033U, 0131U, 0132U, 0135U, 0361U, 0544U, 0550U, 0551U): Remove from capitated lookup tables and discontinue use for HMO/HMO-POS members unless they meet non-capitated exception criteria in Attachments B1/B2. ADDED to non-capitated hospital laboratory (87812): Configure system to recognize 87812 as eligible for reimbursement at outpatient hospital laboratory per Attachment B2 criteria. Verify member's designated capitated site before processing. Reference the updated policy MA00.030am on medpolicy.ibx.com (supersedes MA00.030aj). Claims for new capitated codes sent to non-capitated sites will be denied; claims for deleted codes may be denied or require manual review. Billing team must verify all code assignments in system by 12/31/2025 to prevent claim rejections on 01/01/2026.