Skip to main content

Molecular and Genomic Testing Program Update: March 2019

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 have elected 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 codes below when rendered on and after March 1, 2019 in a physician’s office or clinical laboratory:¹

0002M 81186 81293 81336
0003M 81189 81296 81337
81163 81190 81299 81350
81164 81202 81302 81362
81165 81221 81303 81443
81166 81248 81304 81500
81167 81252 81306 81503
81173 81253 81318 81518
81174 81258 81322 S3844
81185 81286 81326 S3850
81596 81289

Effective January 1, 2019, eviCore will no longer conduct pre-service MND reviews of the services represented by the following codes as part of the Molecular and Genomic Testing Program.

81211
81213
81214

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

For more information about this specialty utilization management program, visit our Molecular and Genomic Testing Program web page. If you have questions, please contact your Network Specialist or Ancillary Contracting Specialist.

¹ 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.

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 28, 2018, 10:15 AM ET
Last updated on: November 28, 2018, 10:18 AM ET