Medicare AdvantageBilling CodesMedium impact
MA00.037n, Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus
Independence Blue Cross·Claims & Billing
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
This policy establishes billing guidelines for professional office-based services delivered in outpatient settings located within a facility or on a facility campus under Medicare Advantage plans. The policy clarifies how to properly bill for these services to ensure accurate reimbursement and compliance with MA plan requirements.
Action Required
By December 31, 2025: Billing team must review policy MA00.037n in full to identify specific billing code requirements, modifier usage, and documentation standards for office-based services performed in facility-based settings. Obtain complete policy text from https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2026#medicare-advantage-ma00-037n-billing-for-professional-office to determine which CPT/HCPCS codes are affected and update billing system rules accordingly. Train providers and billing staff on proper place-of-service coding and billing requirements for facility-campus locations before January 1, 2026. Update encounter forms and billing software to reflect any new requirements. Failure to comply may result in claim denials or recoupment of improperly billed claims.