Notification



Notification Issue Date:



Policy Attachment


Attachment to Policy # 06.02.35w


Attachment:A

Policy #:06.02.35w

Description:Services that are Considered Medically Necessary

Title:Genetic Testing (Independence Administrators)


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 are considered medically necessary and, therefore, covered for an individual when the testing has a direct effect on the management and clinical care of the individual being tested.

Code
0023U
81206
81207
81208
81210
81245
81257
81261
81262
81263
81264
81265
81266
81267
81268
81315
81316
81370
81371
81372
81373
81374
81375
81376
81377
81378
81379
81380
81381
81382
81383
81400
81401
81402
81403
81404
81405
81406
81407
81408
82955
82960
87152
87153
87493
87631
87632
87633
87661
87902
87910
87912
88182
88245
88248
88249
88261
88262
88263
88264
88267
88269
88280
88283
88285
88289
S3840
S3841
S3842
S3845
S3846
S3849
S3850
S3853
S3865
S3866


Version Effective Date: 01/01/2020
Version Issued Date: 12/31/2019
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.