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Medical Policy Revision: Cytochrome p450 Genotyping

Effective September 5, 2016, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for genotyping test cytochrome p450 (CYP450).

Our medical policy, Cytochrome p450 Genotyping*, identifies circumstances when genotyping to determine CYP450 genetic polymorphisms for the purpose of aiding in the choice of drug or dose to increase efficacy and/or avoid toxicity would be considered medically necessary or investigational.

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

* Formerly titled Cytochrome p450 Genotyping (Amplichip) for Personalized Medicine Management.

Based on the guidelines of our medical policy, Cytochrome p450 Genotyping:

  • CPT® code 81225 submitted on claims for services provided on and after September 5, 2016 will be denied as an investigational service regardless of the submitted diagnosis.
  • Claims that include CPT code 81226 for services provided on and after September 5, 2016 when submitted with certain diagnosis code(s) will pend while information is requested and reviewed to help us determine if the service in question is to be considered medically necessary or investigational.

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 5, 2016.

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

Published on: June 7, 2016, 09:26 a.m. ET
Last updated on: November 25, 2020, 00:23 a.m. ET