Medicare AdvantageCoverageMedium impact
MA06.006g, Lyme Disease: Diagnosis and Intravenous (IV) Antibiotic Therapy
Independence Blue Cross·Infectious Disease, Rheumatology, Neurology +3 more·Medical Policy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage Policy MA06.006g has been superseded by MA06.006h effective 12/29/2025. New coverage includes: PCR testing for Lyme disease diagnosis in immunodeficient individuals and synovial fluid PCR for Lyme arthritis; five new HCPCS home infusion therapy codes (S9497-S9503); CPT 87475 reclassified from experimental to medically necessary; and CPT 0580U added as experimental/investigational. The iDart Lyme IgG ImmunoBlot kit remains experimental.
Action Required
By 12/29/2025: (1) Billing team must update system to recognize CPT 87475 (Borrelia burgdorferi direct probe technique) as medically necessary rather than experimental—no prior authorization required. (2) Add new HCPCS home infusion codes S9497, S9500, S9501, S9502, and S9503 to billing system as medically necessary for antibiotic, antiviral, or antifungal therapy at specified frequency intervals. Update billing rules to use appropriate code based on infusion schedule (every 3, 6, 8, 12, or 24 hours). (3) Billing team must flag CPT 0580U as experimental/investigational—require prior authorization before billing. (4) Coding/clinical staff must educate providers that PCR testing of synovial fluid is now covered for seropositive individuals with suspected Lyme arthritis to inform therapeutic decisions. (5) Update encounter forms and clinical decision support to reflect new diagnostic and treatment coverage criteria. Claims submitted with outdated policy references or for experimental tests without prior authorization will be denied.