Medicare AdvantageAdministrativeMedium impact
MA00.010au, 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, PM&R (Physical Medicine & Rehab), Diagnostic Imaging·Network
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Updated PPO network rules for Medicare Advantage plans affecting specialty services including durable medical equipment, laboratory, radiology, and physical medicine/rehabilitation services. This policy change modifies network provider requirements and referral processes for these specialty services.
Action Required
Before October 1, 2025: Billing team must review updated PPO network rules for Medicare Advantage specialty referrals. Verify that all DME, lab, radiology, and PM&R providers are in-network before referring MA patients. Update referral workflows to comply with new network requirements. Non-compliance may result in claim denials or patient balance billing issues.