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Molecular and Genomic Testing Program Update: December 2020

Horizon BCBSNJ will implement changes to the services included as part of our Molecular and Genomic Testing Program, administered by eviCore healthcare (eviCore) for members enrolled in Horizon BCBSNJ 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 December 15, 2020 in a physician’s office or clinical laboratory, eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the services represented by the following Proprietary Laboratory Analyses (PLA) codes:

  • 0016M

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.

MND requirements will 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: November 9, 2020, 02:28 a.m. ET
Last updated on: April 27, 2021, 06:30 a.m. ET