Medicare AdvantageReimbursementMedium impact
MA00.033q, Services Paid Above Capitation for Health Maintenance Organization (HMO) and Health Maintenance Organization Point-of-Service (HMO-POS) Primary Care Providers
Independence Blue Cross·Family Medicine, Internal Medicine, General Practice +1 more·Medical Policy
Effective date
Nov 26, 2025
We identified it
Jun 19, 2026
Summary
This is a reissued policy for Medicare Advantage HMO and HMO-POS plans regarding services that are paid above the standard capitation rate for primary care providers. The policy was reposted on 11/26/2025 with the same effective date, suggesting clarifications or corrections to the original policy.
Action Required
By November 26, 2025: Billing team should review the complete policy document at the provided URL to understand which specific services are paid above capitation for Medicare Advantage HMO and HMO-POS plans. Update billing procedures and fee schedules accordingly for affected primary care services to ensure proper reimbursement expectations.