Medicare AdvantageAdministrativeMedium impact
MA00.010at, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·PM&R (Physical Medicine & Rehab), Radiology·Network
Effective date
Apr 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated PPO network rules for specialty services including durable medical equipment, laboratory, radiology, and physical medicine/rehabilitation services. This policy change affects how providers deliver these services within the PPO network structure for Medicare Advantage members.
Action Required
Before April 1, 2025: Billing team must review updated PPO network rules for DME, lab, radiology, and PM&R services. Verify current network status for specialty service providers used by practice. Update referral processes to ensure compliance with new network requirements. Contact Medicare Advantage plans to clarify specific network restrictions that may affect patient access to services.