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Medical Policy Revision: Miscellaneous Genetic and Molecular Diagnostic Tests

Effective December 26, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy, Miscellaneous Genetic and Molecular Diagnostic Tests.

Access our Medical Policy Manual to review this medical policy content.¹


Regardless of the submitted diagnosis code(s), claims submitted for services provided on and after December 26, 2019 to patients enrolled in Horizon BCBSNJ commercial, Administrative Services Only (ASO), or Medicare Advantage (MA) plans will be processed as follows.

  • The services represented by CPT® code 0084U will be denied as experimental/investigational, non-covered services.

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been canceled or postponed, the changes will be applied to claims for dates of service on and after December 26, 2019.

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

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

Published on: September 25, 2019, 09:26 AM ET
Last updated on: September 24, 2019, 09:30 AM ET