Medicare AdvantageCoverageMedium impact
MA06.013e, Serodiagnosis of Inflammatory Bowel Disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test
Independence Blue Cross·NJ · Gastroenterology, Pathology, Internal Medicine·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA06.013e reissued on 06/10/2026 maintains its position that serodiagnosis of inflammatory bowel disease (IBD) and the Prometheus® IBD sgi Diagnostic™ Test remain experimental/investigational and are not covered under Medicare Advantage plans. This is a continuation of existing policy with no substantive coverage changes.
Action Required
Billing team must maintain current denial procedures for all serodiagnostic IBD tests including CPT codes 0164U, 83516, 83520, and 88350 on Independence Blue Cross Medicare Advantage plans. No workflow changes are required as this represents a reissue of existing policy. Continue denying claims for these services as experimental/investigational. Verify that billing system rules for IBD serology denials remain in place. No new prior authorization requirement exists; these services remain non-covered.