Notification

eviCore Lab Management Program (Independence)


Notification Issue Date: 12/02/2019



Policy Attachment


Attachment to Policy # 06.02.52o


Attachment:B

Policy #:06.02.52o

Description:Procedure Codes Requiring Prepayment Reviews

Title:eviCore Lab Management Program (Independence)


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 FOLLOWING PROCEDURE CODES REPRESENTING LABORATORY TESTS WILL UNDERGO PREPAYMENT REVIEWS BY CARECORE NATIONAL, LLC d/b/a EVICORE HEALTHCARE:

Molecular Pathology (Genetic/Genomic Testing)
Code
0008U
0009U
0010U
0023U
0027U
0037U
0046U
0049U
0068U
0086U
0096U
0097U
0098U
0099U
0100U
0109U
0112U
0115U
0140U
0141U
0142U
0151U
0152U
0154U
0155U
81105
81106
81107
81108
81109
81110
81111
81112
81120
81121
81161
81170
81171
81172
81175
81176
81177
81178
81179
81180
81181
81182
81183
81184
81187
81188
81200
81204
81205
81206
81207
81208
81209
81210
81218
81219
81220
81224
81233
81234
81235
81236
81237
81239
81240
81241
81242
81243
81244
81245
81246
81247
81250
81251
81254
81255
81256
81260
81261
81262
81263
81264
81265
81266
81267
81268
81270
81271
81272
81273
81274
81275
81276
81284
81285
81287
81288
81290
81301
81305
81309
81310
81311
81312
81314
81315
81316
81320
81324
81329
81330
81331
81332
81333
81334
81340
81341
81342
81344
81345
81370
81371
81372
81373
81374
81375
81376
81377
81378
81379
81380
81381
81382
81383
81420
81422

Multianalyte Assays with Algorithmic Analyses (MAAA) (Genetic/Genomic Testing)
Code
81507


Molecular (Nucleic Acids) Infectious Testing
Code
0500T
87149
87150
87152
87153
87471
87472
87475
87476
87480
87481
87482
87483
87485
87486
87487
87490
87491
87492
87493
87495
87496
87497
87498
87500
87501
87502
87503
87505
87506
87507
87510
87511
87512
87516
87517
87520
87521
87522
87525
87526
87527
87528
87529
87530
87531
87532
87533
87534
87535
87536
87537
87538
87539
87540
87541
87542
87550
87551
87552
87555
87556
87557
87560
87561
87562
87563
87580
87581
87582
87590
87591
87592
87623
87624
87625
87631
87632
87633
87634
87640
87641
87650
87651
87652
87653
87660
87661
87662
87797
87798
87799
87800
87801
87900
87901
87902
87903
87904
87906
87910
87912
G0476

Molecular Cytopathology Procedures (Flow Cytometry, In Situ Hybridization)
Code
88120
88121
88182
88184
88185
88187
88188
88189

Cytogenetics
Code
88230
88233
88235
88237
88239
88240
88241
88245
88248
88249
88261
88262
88263
88264
88267
88269
88271
88272
88273
88274
88275
88280
88283
88285
88289
88291

Molecular Surgical Pathology Procedures (Immunohistochemistry, In Situ Hybridization)
Code
88341
88342
88344
88360
88361
88364
88365
88366
88367
88368
88369
88373
88374
88377
88380
88381
88387
88388

Unlisted Molecular Codes (When Reported for Genetic/Genomic Testing)
Code
88199
88299
89240

Molecular HCPCS Codes (Genetic/Genomic Testing)
Code
Narrative
G0452
Molecular pathology procedure; physician interpretation and report
S3849
Genetic testing for niemann-pick disease
S3853
Genetic testing for myotonic muscular dystrophy



Version Effective Date: 01/01/2020
Version Issued Date: 12/31/2019
Version Reissued Date: N/A

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.