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Medical Policy Revision: Gene Expression-Based Assays for Cancers of Unknown Primary

Effective October 30, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for gene expression profiling using the Pathwork® Tissue of Origin test.

According to the guidelines of our revised medical policy, Gene Expression-Based Assays for Cancers of Unknown Primary (formerly titled Microarray-Based Gene Expression Testing for Cancers of Unknown Primary), gene expression profiling using the Pathwork® Tissue of Origin test is considered investigational to evaluate the site of origin of a tumor of unknown primary, and to distinguish a primary from a metastatic tumor.

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


Based on the guidelines of our revised medical policy, Gene Expression-Based Assays for Cancers of Unknown Primary, CPT® code 81504 included on claims for services provided on or after October 30, 2017 will be denied as an experimental/investigational and non-covered 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 30, 2017.

Pathwork® is a registered trademark of Cancer Genetics Inc.

CPT is a registered trademark of the American Medical Association.

Published on: August 1, 2017, 12:02 p.m. ET
Last updated on: August 1, 2017, 12:02 p.m. ET