Medicare AdvantageCoverageMedium impact
Medicare Advantage plans laboratory network hospital allowable test listing
Blue Cross Blue Shield of Rhode Island·RI·Physician / Facility
Effective date
Jun 1, 2021
We identified it
Jun 19, 2026
Summary
Effective June 1, 2021, Medicare Advantage plans updated their laboratory network restrictions for hospital CLIA-certified labs outside their outpatient laboratory network. The network restrictions no longer apply to physician laboratories or urgent care facilities.
Action Required
Review the updated allowable code list for hospital CLIA-certified labs outside the Medicare Advantage plan outpatient laboratory network. Verify that physician laboratories and urgent care facilities are no longer subject to network restrictions when ordering lab tests for Medicare Advantage patients.