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Medical Policy Implementation: Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies

Effective September 5, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for genetic testing for an inherited peripheral neuropathy.

According to the guidelines of our new medical policy, Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies, genetic testing for an inherited peripheral neuropathy is considered investigational for all indications including, but not limited to, confirmation of a clinical diagnosis of an inherited peripheral neuropathy.

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

Based on the guidelines of our medical policy, Genetic Testing for the Diagnosis of Inherited Peripheral Neuropathies AND the submitted diagnosis code(s):

  • Claims that include CPT® codes 81403, 81404, 81405 and/or 81406 for services provided on and after September 5, 2016 will pend when submitted with certain diagnosis code(s) while information is requested and reviewed to help us determine if the service is to be considered medically necessary or investigational.
  • CPT codes 81324, 81325 and/or 81326 included on claims for services provided on and after September 5, 2016 will be denied as investigational services 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 September 5, 2016.

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

Published on: June 7, 2016, 09:30 a.m. ET
Last updated on: November 25, 2020, 00:23 a.m. ET