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Medical Policy Implementation: Gene Expression Profiling for Uveal Melanoma

Effective February 1, 2019, Horizon Blue Cross Blue Shield of New Jersey will change the way we process certain claims based on the implementation of a new medical policy, Gene Expression Profiling for Uveal Melanoma.

Access our Medical Policy Manual to review this medical policy content.¹

Claims submitted for services provided February 1, 2019 and after to patients enrolled in Horizon BCBSNJ Commercial, Administrative Services Only (ASO) and Medicare Advantage (MA) plans will be processed as noted below.

  • CPT® code 0059U will be denied, regardless of the submitted diagnosis code(s), as an experimental/investigational, noncovered service.

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 on and after February 1, 2019.

¹ The content of Horizon BCBSNJ medical policies that apply to services provided to Horizon BCBSNJ MA members may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). Horizon BCBSNJ follows Centers for Medicare & Medicaid Services (CMS) guidelines, National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) in our processing of claims for services provided to Horizon BCBSNJ MA members. For those services where no LCD or NCD exists, claims for services provided to MA members will be processed based on our policy guidelines.

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

Published on: November 1, 2018, 12:41 PM ET
Last updated on: November 5, 2018, 01:41 AM ET