MA PPO
Advanced Search

Policy Attachment

MA00.026w
C
MA00.026w
Procedures/Services Not Eligible for Reimbursement
Always Bundled Procedure Codes

​

Procedures and Services Not Eligible for Reimbursement

This list is not all-inclusive and may not include procedures/services that have been identified as not eligible for separate reimbursement in more specific policies. Additions and deletions will be made as changes occur or the reimbursement position of a procedure/service changes.


​Procedure Code​
​0591T
98000
98001
98002
98003
98004
98005
98006
98007
98008
98009
98010
98011
98012
98013
98014
98015
98016
​99242
​99243
​99244
​99245
​99252
​99253
​99254
​99255
0592T
0593T
A4305
A4306
A4570
A4580
A4590
G0076
G0077
G0078
G0079
G0080
G0081
G0082
G0083
G0084
G0085
G0086
G0087
G0519
G0520
G0521
G0522
G0523
G0524
G0525
G0526
G0527
G0528
G0529
G0530
G0531
G0532
G0533
G0534
G0535
G0536
G0546
G0547
G0548
G0549
G0550
G0551
G2000
G2020
​G2168
​G2169
G9037
G9038
G9873
G9874
G9875
G9876
G9877
G9878
G9879
G9882
G9883
G9884
G9885
G9891
​H2038
Q0521

01/01/2025
02/25/2025
N/A
Claim Payment Policy Bulletin
Medicare Advantage
b8057771-0f7d-4c4f-9e51-9bbd0cf78521
Yes
Connect with Us

2025 Independence Blue Cross

Independence Blue Cross is a subsidiary of Independence Health Group, Inc. — independent licensees of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.