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Medical Policy Revision: Genetic Testing for Inherited Thrombophilias

Effective April 22, 2019, Horizon BCBSNJ will revise the criteria and guidelines of our medical policy, Genetic Testing for Inherited Thrombophilias. We encourage you to access our Medical Policy Manual to review this medical policy content.¹

The revisions to be implemented include a change in our position on MTHFR variant analysis as well as changes to the medically necessary indications related to Factor II/Prothrombin testing and Factor V Leiden testing.

This policy revision will not result in any material adverse change to how we currently process claims for services provided to your patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO) or Medicare Advantage (MA) plans.

¹ The content of Horizon BCBSNJ medical policies that apply to Horizon BCBSNJ MA 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.

Published on: March 22, 2019, 13:29 p.m. ET
Last updated on: April 27, 2021, 09:57 a.m. ET