Medicare AdvantageCoverageMedium impact
MA00.001f, Not Medically Necessary Services and Obsolete or Unreliable Diagnostic Tests
Independence Blue Cross·Ophthalmology, Wound Care, Dermatology +2 more·Medical Policy
Effective date
Jan 12, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued MA00.001f effective 01/12/2026 with no changes to the core policy structure, but added two new services to the non-covered list: photocoagulation of macular drusen and electrical/electromagnetic stimulation for wound care (with specific exceptions). Three new billing codes were added: CPT 67299 and HCPCS codes G0282 and G0295. Billing teams must update denial logic and billing system configurations to reflect these additions.
Action Required
By 01/12/2026, billing team must: (1) Update billing system to deny claims for CPT 67299 (photocoagulation of macular drusen) as not medically necessary under Independence Blue Cross MA plans; (2) Configure system to deny claims for HCPCS G0282 and G0295 (electrical and electromagnetic stimulation for wound care) EXCEPT when used for chronic stage III/IV pressure ulcers, arterial insufficiency ulcers, diabetic ulcers, or venous stasis ulcers—these exceptions require modifier or authorization logic to allow payment in approved scenarios; (3) Update provider and patient communication materials to reflect these non-covered services; (4) Train billing staff to recognize these codes and apply appropriate denial codes in claims processing. Failure to implement will result in improper payment of non-covered claims.