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Independence Blue CrossMedicare Advantage · Billing Codes · Medical Policy · Oncology, Genetics, Pathology +4 moreMedium impact

MA06.034q, eviCore Lab Management

Act
by Apr 1, 2025
Effective date
Apr 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA06.034v to add 13 new procedure codes (0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, G0567) and revised the narrative for code 0288U effective 04/01/2025. All genetic/genomic tests and certain molecular/cytogenetic tests continue to require pre-service and/or prepayment reviews through eviCore.

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What to do

by Apr 1, 2025 · 7 steps
01Billing team must update billing system to include newly added procedure codes 0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, and G0567 in the eviCore Lab Management pre-service and prepayment review workflows.
02Verify code 0288U narrative update in system documentation.
03For any claims with these codes.
04Ensure pre-service authorization is obtained through eviCore before service delivery for applicable codes per Attachment A.
05All codes require prepayment review through eviCore before reimbursement.
06Update encounter forms and provider notifications to reflect new codes requiring eviCore authorization.
07Without proper eviCore authorization, claims will be denied as not meeting coverage criteria or not medically necessary.

Codes mentioned

G0567

Original notice

MA06.034q, eviCore Lab Management
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
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Related policy hubs

Independence Blue Cross policiesOncologyGeneticsPathologyInternal MedicineOB-GYNCardiologyGastroenterologyCode G0567

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