Active Policy Notifications
Select Cardiology Guidelines
News & Announcements
Notification Issue Date:
to Policy #
Services that are Considered Medically Necessary
Inclusion of a code in this table does not imply reimbursement. Eligibility, benefits, limitations, exclusions, precertification/referral requirements, provider contracts, and Company policies apply.
The codes listed below are updated on a regular basis, in accordance with nationally accepted coding guidelines. Therefore, this policy applies to any and all future applicable coding changes, revisions, or updates.
In order to ensure optimal reimbursement, all health care services, devices, and pharmaceuticals should be reported using the billing codes and modifiers that most accurately represent the services rendered, unless otherwise directed by the Company.
The Coding Table lists any CPT, ICD-9, ICD-10, and HCPCS billing codes related only to the specific policy in which they appear.
The following procedure codes and services are considered medically necessary and, therefore, covered when the general molecular diagnostic testing criteria in the main policy are met.
Tier 02 CPT codes (81400 - 81408) for genetic testing services are nonspecific in nature. Individual tests which do not have a specific genetic testing code may be represented with Tier 02 CPT genetic testing codes. In this attachment there is a list of specific genetic tests for each of the Tier 02 CPT genetic testing codes, which may be considered medically necessary and, therefore, covered when the general molecular diagnostic testing criteria in the main policy are met.
Physician Interpretation and Report
HCPCS code G0452 is considered medically necessary and, therefore, covered when performed for services that are considered medically necessary by the Company.
Molecular pathology procedure; physician interpretation and report
Version Effective Date:
Version Issued Date:
Version Reissued Date:
Connect with Us
© 2017 Independence Blue Cross.
Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.