Medicare AdvantageAdministrativeMedium impact
MA00.010as, PPO Network Rules for Provision of Specialty Services for Durable Medical Equipment and Laboratory, Radiology, and Physical Medicine and Rehabilitative Services
Independence Blue Cross·Radiology, Physical Therapy, PM&R (Physical Medicine & Rehab)·Network
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
New PPO network rules have been established for specialty services including durable medical equipment, laboratory, radiology, and physical medicine/rehabilitation services under Medicare Advantage plans. This policy defines network requirements and provision guidelines for these specialty services effective January 1, 2025.
Action Required
By February 15, 2025: Billing team must review current referral patterns for DME, lab, radiology, and physical medicine services to ensure compliance with new PPO network rules. Update provider directories and verify network status for specialty service providers. Front desk staff should confirm network participation before scheduling DME, lab, radiology, and PM&R services to avoid potential claim denials or patient balance billing issues.