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Blues highlight medical, benefit policy changes

Sunday, January 15, 2012

Procedures for which Blue Cross Blue Shield of Michigan have changed a billing guideline or added a new payable group appear under Updates to Payable Procedures.

UPDATES TO PAYABLE PROCEDURES

S3853, 81404 Basic Benefit Policy
Genetic testing for the presence of myotonic muscular dystrophy Type I has been established. It may be considered a useful diagnostic option in the diagnosis of myotonic muscular dystrophy Type I. Inclusionary and exclusionary guidelines have been updated, effective Jan. 1, 2012.
Inclusionary Guidelines
   • The member displays clinical features of DM1, or is at risk of inheriting the mutation, and:
      o The result of the test will directly impact the treatment being delivered
      o After history, physical examination, and completion of conventional diagnostic studies (e.g. muscle testing via EMG, muscle biopsy, etc.), a definitive diagnosis remains uncertain
   • For prenatal diagnosis or preimplantation genetic diagnosis of DM1
Exclusionary Guidelines
   • For prenatal diagnosis or preimplantation genetic diagnosis of DM2
   • For diagnosis of DM2 in asymptomatic adults who are at an increased risk of DM2 through a positive family history and are considering reproductive options
   • For confirmation of a diagnosis of DM1 or DM2 in symptomatic patients in the absence of classical symptoms or a family history of the disorder
   • For diagnosis of DM1 or DM2 in asymptomatic adults who are at an increased risk of DM1 or DM2 through a positive family history
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Industry News
Blue Cross Blue Shield Michigan
Michigan

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