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Medical Policy Update: Gene Expression-Based Assays for Cancers of Unknown Primary

Effective June 11, 2018, the guidelines of our medical policy, Gene Expression-Based Assays for Cancers of Unknown Primary, will also be applied to claims for services provided to patients enrolled in Horizon Blue Cross Blue Shield of New Jersey Medicare Advantage (MA) plans.

Review the guidelines of our medical policy, Gene Expression-Based Assays for Cancers of Unknown Primary, in our Medical Policy Manual


Based on the guidelines of our medical policy, Gene Expression-Based Assays for Cancers of Unknown Primary, claims for services provided on and after June 11, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • CPT® code 81504 will be denied as an experimental/investigational and non-covered service 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 on and after June 11, 2018.

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

Published on: May 9, 2018, 07:55 AM ET
Last updated on: May 9, 2018, 08:12 AM ET