Notification



Notification Issue Date:



Policy Attachment

Attachment to Policy # MA06.017r


Attachment:D

Policy #:MA06.017r

Description:Services that are Considered Exclusions

Title:Molecular Diagnostics


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 molecular diagnostic services are not covered by the Company because these services are not covered by Medicare. Therefore, these services are not eligible for reimbursement consideration.
81161
81200
81205
81209
81220
81221
81222
81223
81224
81243
81244
81260
81302
81303
81304
81327
81330
81331
S3849 Genetic testing for Niemann-Pick disease



Version Effective Date: 01/01/2020
Version Issued Date: 01/03/2020
Version Reissued Date: N/A

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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.