Medicare AdvantageCoverageMedium impact
MA11.068f, Sentinel Lymph Node Biopsy and Mapping
Independence Blue Cross·General Surgery, Oncology, OB-GYN +1 more·Medical Policy
Effective date
Aug 25, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA11.068f for Sentinel Lymph Node Biopsy and Mapping has updated medical necessity criteria effective August 25, 2025. This change affects the requirements providers must meet to demonstrate medical necessity for these procedures.
Action Required
Before August 25, 2025: Billing team and providers must review updated medical necessity criteria for sentinel lymph node biopsy and mapping procedures. Update documentation templates and ensure all sentinel lymph node procedures meet the new medical necessity requirements. Claims not meeting updated criteria may be denied.