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·PM&R (Physical Medicine & Rehab), Radiology, Diagnostic Imaging·Network
Effective date
Jan 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 effective January 1, 2025. This policy change affects how these services must be obtained through the PPO network structure.
Action Required
Immediately: Review updated PPO network requirements for DME, lab, radiology, and PM&R services for Medicare Advantage patients. Verify providers are using in-network facilities for these specialty services to avoid claim denials or increased patient cost-sharing. Update referral processes to ensure network compliance.