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Medical Policy Implementation: Genetic Testing for PALB2 Mutations

Effective July 22, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for Genetic Testing for PALB2 Mutations.

Based on the guidelines of our medical policy, Genetic Testing for PALB2 Mutations, claims submitted for services provided on and after July 22, 2015 that include CPT® code 81406 and one or more of the diagnosis codes listed below will pend while information required to determine medical appropriateness is requested and reviewed:

ICD-9 diagnosis codes: 157.0, 157.1, 157.2, 157.3, 157.4, 157.8, 157.9, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9, 198.2, 198.81, 230.9, 233.0, 238.3, 239.3, 611.72, 611.79, 611.89, 611.9, 793.80, 793.89, V10.3, V10.09, V16.0, V16.3

ICD-10 diagnosis codes: C25.0, C25.1, C25.2, C25.3, C25.4, C25.7, C25.8, C25.9, C50.011, C50.012, C50.019, C50.111, C50.112, C50.119, C50.211, C50.212, C50.219, C50.311, C50.312, C50.319, C50.411, C50.412, C50.419, C50.511, C50.512, C50.519, C50.611, C50.612, C50.619, C50.811, C50.812, C50.819, C50.911, C50.912, C50.919, C79.2, C79.81, D01.7, D01.9, D05.00, D05.01, D05.02, D05.10, D05.11, D05.12, D05.80, D05.81, D05.82, D05.90, D05.91, D05.92, D48.60, D48.61, D48.62, D49.3, N63, N64.51, N64.52, N64.53, N64.59, N64.89, N64.9, R92.8, R92.1, Z85.3, Z85.068, Z85.07, Z85.09, Z80.0, Z80.3

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 with dates of service on and after July 22, 2015.

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

Published on: April 22, 2015, 10:00 a.m. ET
Last updated on: November 24, 2020, 23:35 p.m. ET