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Medical Policy Implementation: Novel Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease

Effective October 1, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for the measurement of lipid and nonlipid risk factors in regard to the assessment and management of cardiovascular disease.

According to the guidelines of our medical policy, Novel Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease*, the measurement of novel lipid and nonlipid risk factors (i.e., apolipoprotein B, apolipoprotein A-I, apolipoprotein E, B-type natriuretic pepetide, cystatin C, fibrinogen, leptin, LDL subclass, HDL subclass, lipoprotein[a]) is considered investigational as an adjunct to LDL cholesterol in the risk assessment and management of cardiovascular disease.

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

* Formerly titled Apolipoprotein E (APOE) Genotype or Phenotype in the Management of Cardiovascular Disease.

Based on the guidelines of our revised medical policy, Novel Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease, claims that include CPT® codes 83700, 83701, and/or 83704 for services provided on and after October 1, 2016 will be denied as an investigational service 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 October 1, 2016.

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

Published on: June 30, 2016, 08:00 a.m. ET
Last updated on: November 25, 2020, 00:29 a.m. ET