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Molecular and Genomic Testing Program Update: January 2020

Horizon Blue Cross Blue Shield of New Jersey 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.

  • eviCore will conduct pre-service Medical Necessity Determination (MND) reviews of the additional diagnostic testing services represented by the recently accepted codes noted below when rendered on and after January 1, 2020 in a physician’s office or clinical laboratory:¹

    0153U
    0156U
    0157U
    0158U
    0159U
    0160U
    0161U
    0162U
    81277
    81307
    81308
    81522
    81542
    81552

  • Effective January 1, 2020, services represented by CPT® code 0081U will no longer require pre-service MND review as part of the Molecular and Genomic Testing Program.

Review the complete list of molecular and genomic diagnostic testing services that require pre-service MND reviews.

More information about our Molecular and Genomic Testing Program is available. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹MND 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.


PRE-SERVICE MND REVIEWS
To obtain pre-service MND from eviCore (or to validate that a pre-service MND was requested and/or approved):

  • Visit.eviCore.com; or
  • Call 1-844-224-0493, between 7 a.m. and 7 p.m., Eastern Time.

Review the guidelines eviCore uses to conduct MND reviews as part of the Molecular and Genomic Testing Program.

Published on: November 29, 2019, 01:23 AM ET
Last updated on: November 26, 2019, 04:49 AM ET