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Medical Policy Implementation: BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia

Effective September 5, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for BCR-ABL1 testing.

According to the guidelines of our new medical policy, BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia, BCR-ABL1 qualitative testing, BCR/ABL1 testing for messenger RNA transcript levels by quantitative real-time reverse transcription-polymerase chain reaction, and/or evaluation of ABL kinase domain point mutations may be considered not medically necessary or investigational services.

We encourage you to review this policy in our online Medical Policy Manual.

Based on the guidelines of our medical policy, BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia AND the submitted diagnosis codes(s):

  • Claims that include CPT® codes 81170, 81206, 81207, 81208 and/or 81403 for services provided on and after September 5, 2016 may pend when submitted with certain diagnosis code(s) while we request and review information to help determine if the service(s) in question are considered medically necessary.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after September 5, 2016.

CPT® is a registered mark of the American Medical Association.

Published on: June 7, 2016, 09:34 a.m. ET
Last updated on: November 25, 2020, 00:24 a.m. ET