Medical Policy Implementation: Genetic Testing for PTEN Hamartoma Tumor Syndrome

Effective September 14, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for genetic testing for a PTEN (phosphatase and tensin homologue on chromosome 10) mutation.

Based on the guidelines of our new medical policy, Genetic Testing for PTEN Hamartoma Tumor Syndrome, claims that include CPT® codes 81321, 81322 or 81323 for services provided on and after September 14, 2015 will pend while information required to determine medical necessity is requested and reviewed.

Review this 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 september 14, 2015.

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