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Medical Policy Implementation: Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies

Effective April 25, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for expanded molecular panel testing of cancers.

According to the guidelines of our medical policy, Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies, the use of expanded cancer mutation panels for selecting targeting cancer treatment is generally considered investigational.

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

Based on the guidelines of our new medical policy, Expanded Molecular Panel Testing of Cancers to Identify Targeted Therapies:

  • Claims that include CPT® codes 81445 or 81450 for services provided on and after April 25, 2016 will pend while we request details about the panel of genes being billed to help us determine if the panel in question is considered medically necessary or investigational.
  • CPT code 81455 included on claims for services provided on and after April 25, 2016 will be denied as an investigational service regardless of the submitted diagnosis code(s).

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 April 25, 2016.

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

Published on: January 26, 2016, 14:00 p.m. ET
Last updated on: November 24, 2020, 23:50 p.m. ET