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Medical Policy Revision: Genetic Cancer Susceptibility Panels Using Next Generation Sequencing

Effective February 13, 2017, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain claims for testing panels used to determine genetic cancer susceptibility.

Our revised medical policy, Genetic Cancer Susceptibility Panels Using Next Generation Sequencing, identifies when the use of next generation sequencing to determine genetic cancer susceptibility would be considered medically necessary or investigational.

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


Based on the guidelines of our revised medical policy, Genetic Cancer Susceptibility Panels Using Next Generation Sequencing, CPT® codes 81432 and/or 81433 included on claims for services provided on and after February 13, 2017 will be denied as non-covered investigational services 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 February 13, 2017.

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

Published on: November 15, 2016, 06:00 a.m. ET
Last updated on: November 25, 2020, 00:35 a.m. ET