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Medical Policy Revision: Alpha 1-Proteinase Inhibitors (Human)

Effective July 23, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for genetic testing performed to identify mutations in certain genes.

We encourage you to visit our Medical Policy Manual to review the guidelines of our medical policy, Alpha 1-Proteinase Inhibitors (Human) [Prolastin-C®, Aralast NP®, Zemaira® and Glassia®], which identify when these tests are considered medically necessary.


Based on the guidelines included in our medical policy, Alpha 1-Proteinase Inhibitors (Human) [Prolastin-C, Aralast NP, Zemaira, and Glassia], claims for services provided on and after July 23, 2018 will be processed as follows:

  • HCPCS codes J0256, J0257 and/or S9346 included on claims for services provided to patients 18 years of age and older may be denied – based on the submitted diagnosis code(s) – as services not related to the submitted diagnosis code(s).

  • HCPCS codes J0256, J0257 and/or S9346 included on claims for services provided to patients younger than 18 years of age will be denied – regardless of the submitted diagnosis code(s) – as experimental/investigational, non-covered services.

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 July 23, 2018.

This document contains references to brand name prescription medicines that are trademarks or registered marks of pharmaceutical manufacturers that are not affiliated with Horizon Blue Cross Blue Shield of New Jersey, the Blue Cross and Blue Shield Association.

Published on: April 23, 2018, 12:25 p.m. ET
Last updated on: April 23, 2018, 12:27 p.m. ET