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MA00.005aq, Experimental/Investigational Services

Independence Blue Cross·Gastroenterology, General Surgery, Vascular Surgery +1 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Days to comply
—

Summary

Independence Blue Cross Medicare Advantage policy MA00.005at (effective 10/01/2025) designates 11 new CPT codes, 4 new HCPCS codes, and 4 unlisted code services as experimental/investigational and therefore non-covered. Simultaneously, 3 CPT codes (43497, 0338T, 0339T) and 2 additional CPT codes (0569T, 0570T) are removed from the experimental list because they are now considered medically necessary or addressed in other policies. Billing teams must immediately identify claims using these codes and implement denial management strategies.

Action Required

Action needed
By September 30, 2025: Billing team must update revenue cycle system to automatically deny claims containing CPT codes 0577U, 0579U, 0580U, 0581U, 0584U, 0589U, 0591U, 0594U, 0596U, 0598U, 0599U, 0415U; HCPCS codes C1740, C1742, C8006, Q4391; and unlisted codes 38999, 43499, 43999, 45399 when associated with lymphaticovenous bypass/anastomosis, Peroral Plication of the Esophagus, or Endoscopic full thickness resection procedures for Medicare Advantage members. Concurrently, remove CPT codes 43497, 0338T, 0339T, 0569T, 0570T from the experimental/investigational list in the billing system to allow coverage as medically necessary services. Update denial templates to reference policy MA00.005at and communicate change to providers via staff meeting and email. Failure to implement will result in incorrect denials of now-covered services (43497, 0338T, 0339T, 0569T, 0570T) and missed denials of non-covered experimental services. Verify changes are live in billing software before October 1, 2025.

Affected Billing Codes

43497
C1740
C1742
C8006
Q4391
38999
43499
43999
45399