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Medical Policy Update: Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder and Congenital Anomalies

Effective January 19, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider claims for chromosomal microarray (CMA) testing for the detection of genetic imbalances in infants or children with characteristics of developmental delay/intellectual disability (DD/ID), autism spectrum disorder (ASD) and/or congenital anomalies for patients enrolled in Horizon BCBSNJ Medicare Advantage (MA) plans.

We encourage you to access our Medical Policy Manual to review the guidelines of our medical policy, Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder and Congenital Anomalies.


Based on the guidelines of our medical policy, Genetic Testing for Developmental Delay/Intellectual Disability, Autism Spectrum Disorder and Congenital Anomalies, CPT® codes 81228 and/or 81229 included on claims for services provided on and after January 19, 2018 to patients enrolled in Horizon BCBSNJ MA plans will be denied as experimental/investigational non-covered services 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 for dates of service on and after January 19, 2018.

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

Published on: December 20, 2017, 10:30 a.m. ET
Last updated on: December 20, 2017, 10:43 a.m. ET