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Medical Policy Update: Genetic Testing for Statin-Induced Myopathy

Effective April 13, 2018, the guidelines of our medical policy, Genetic Testing for Statin-Induced Myopathy, 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. Presently the guidelines of this medical policy have not been applied to claims for services provided to MA members.

We encourage you to review this policy content in our Medical Policy Manual.


Based on the guidelines of our medical policy, Genetic Testing for Statin-Induced Myopathy, claims for services provided on and after April 13, 2018 to members enrolled in Horizon BCBSNJ MA plans will be processed as noted below.

  • Claims that include CPT® code 81400 may pend, based on the submitted diagnosis code(s), while information required to determine medical appropriateness is requested and reviewed.
  • CPT code 81328 will be denied as not medically necessary 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 April 13, 2018.

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

Published on: March 13, 2018, 13:45 p.m. ET
Last updated on: March 13, 2018, 13:48 p.m. ET