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Molecular and Genomic Testing Program Update: August 2022

Horizon will add service codes to be included in our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore). This impacts members enrolled in Horizon fully-insured products as well as administrative services only (ASO) accounts that participate in the Molecular and Genomic Testing Program.

For services to be rendered on and after August 31, 2022, in a physician’s office or clinical laboratory, eviCore will also conduct pre-service Medical Necessity Determination (MND) reviews of the services represented by the following, recently added Proprietary Laboratory Analyses (PLA) codes:

Code Short Code Descriptor
0326U TRGT GEN SEQ ALYS PNL 83+
0329U ONC NEO XOME&TRNS SEQ ALYS
0331U ONC HL NEO OPT GEN MAPPING

Review the complete list of molecular and genomic diagnostic testing services subject to MND review as part of this program or review more details about our Molecular and Genomic Testing Program.

If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

eviCore healthcare is an independent company that supports Horizon BCBSNJ in the provision of Medical Necessity Review (PA/MND) of certain molecular and genomic diagnostic testing services that are rendered in a physician’s office or clinical laboratory setting.

MND requirements do not apply to molecular and genomic diagnostic testing services rendered to patients in a hospital Emergency Room, hospital outpatient or inpatient setting or an Ambulatory Surgery Center (ASC).

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

Published on: August 1, 2022, 13:10 p.m. ET
Last updated on: July 28, 2022, 10:02 a.m. ET