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Medical Policy Revision: Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk

Effective August 29, 2019, Horizon BCBSNJ will change the way we consider certain professional claims based on revisions to our medical policy Moderate Penetrance Variants Associated with Breast Cancer in Individuals at High Breast Cancer Risk.

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


Claims submitted for services provided on and after August 29, 2019 to patients enrolled in Horizon BCBSNJ commercial or Administrative Services Only (ASO) plans will be processed as follows.

  • Regardless of the submitted diagnosis code(s), information will be requested to help us determine the medical appropriateness of the services represented by CPT® code 81406. Following our review of medical record information, these services may be denied as experimental/investigational, noncovered 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 August 29, 2019.

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

Published on: May 29, 2019, 03:12 a.m. ET
Last updated on: May 29, 2019, 03:22 a.m. ET