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Medical Policy Revision: Analysis of Proteomic Patterns in Serum to Identify Cancer

Effective September 1, 2021, Horizon BCBSNJ will change the way we consider certain clinical laboratory claims based on a revision to our medical policy, Analysis of Proteomic Patterns in Serum to Identify Cancer.

Access our Medical Policy Manual to review this and other medical policy content.

Clinical laboratory claims testing submitted on claims for services provided September 1, 2021 and after to patients enrolled in Horizon BCBSNJ commercial plans, Administrative Services Only (ASO) employer groups and Horizon BCBSNJ Medicare Advantage plans will be processed as noted below.

  • Regardless of the submitted diagnosis code(s), the services represented by CPT® procedure code 83789 will be denied as experimental/investigational, non-covered services.

The content of Horizon BCBSNJ medical policies that apply to members enrolled in Medicare Advantage plans may include reference to pertinent National Coverage Determinations (NCDs) and/or Local Coverage Determinations (LCDs). We follow Centers for Medicare & Medicaid Services (CMS) guidelines, NCDs and/or LCDs in our processing of claims for services provided to our MA members. For those services where no LCD or NCD exists, claims for MA members will be processed based on our policy guidelines.

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

Published on: May 31, 2021, 08:45 a.m. ET
Last updated on: May 28, 2021, 13:00 p.m. ET