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Medical Policy Revision: BRAF Gene Mutation Testing To Select Melanoma Patients for BRAF Inhibitor Therapy

Effective September 14, 2015, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for BRAF gene mutation testing of patients with melanoma.

Based on the guidelines of our revised medical policy, BRAF Gene Mutation Testing To Select Melanoma Patients for BRAF Inhibitor Therapy, claims submitted for services provided on and after September 14, 2015 that include CPT® code 81210 and one or more of the diagnosis codes listed below will pend while information required to determine medical necessity is requested and reviewed.

ICD-9 diagnosis codes:
172.0, 172.1, 172.2, 172.3, 172.4, 172.5, 172.6, 172.7, 172.8, 172.9, 198.2

ICD-10 diagnosis codes:
C43.0, C43.4, C43.8, C43.9, C43.10, C43.11, C43.12, C43.20, C43.21, C43.22, C43.30, C43.31, C43.39, C43.51, C43.52, C43.59, C43.60, C43.61, C43.62, C43.70, C43.71, C43.72, D03.0, D03.4, D03.8, D03.9, D03.10, D03.11, D03.12, D03.20, D03.21, D03.22, D03.30, D03.39, D03.51, D03.52, D03.59, D03.60, D03.61, D03.62, D03.70, D03.71, D03.72

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 for dates of service on and after September 14, 2015.

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

Published on: June 15, 2015, 14:00 p.m. ET
Last updated on: November 24, 2020, 23:39 p.m. ET