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Medical Policy Revision: Identification of Microorganisms Using Nucleic Acid Probes

Effective April 1, 2021, Horizon BCBSNJ will change the way we consider certain professional claims based on a revision to our medical policy, Identification of Microorganisms Using Nucleic Acid Probes.

Access our Medical Policy Manual to review this medical policy content.


Claims submitted for services provided on and after April 1, 2021 will be processed as indicated below.

For services provided to patients enrolled in Horizon BCBSNJ commercial & Administrative Services Only (ASO) employer groups:

  • Regardless of the submitted diagnosis code(s), the services represented by CPT® code 87510 and 87511 will be denied as experimental/investigational noncovered services.
  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT codes 0098U, 0099U, 0100U, 0115U, 0151U, 87631, 87632 and 87633.
  • Following our review of medical record information, these services may be denied as not medically necessary.

For services provided to patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans:

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT codes 0098U, 0099U, 0100U, 0115U, 0151U, 87631, 87632 and 87633.

Following our review of medical record information, these services may be denied as not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, based on a national coverage determination or local coverage determination.

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

Published on: December 29, 2020, 01:06 a.m. ET
Last updated on: April 23, 2021, 02:05 a.m. ET