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Medical Policy Implementation: Genetic Testing for Hereditary Pancreatitis

Effective June 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for genetic testing for hereditary pancreatitis.

Based on the guidelines of our medical policy, Genetic Testing for Hereditary Pancreatitis, claims submitted for services provided to members under 18 years of age on and after June 22, 2015 that include CPT® codes 81222, 81223, 81401 and 81404 and one of the diagnosis codes listed below will pend while information required to determine medical appropriateness is requested and reviewed.

ICD-9 diagnosis codes: 577.0, 577.1

ICD-10 diagnosis codes: B25.2, K85.0, K85.1, K85.2, K85.3, K85.8, K85.9, K86.0, K86.1

Review this revised policy in our online Medical Policy Manual.

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 June 22, 2015.

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

Published on: March 23, 2015, 08:00 a.m. ET
Last updated on: November 24, 2020, 23:32 p.m. ET