BCBSM Changes to: Basic Benefit and Medical Policy, Group Variations Payment Policy, and Guidelines

81120, 81121, 81246

Basic benefit and medical policy

Codes already established:
81218, 81245, 81310, 81450

Genetic testing for FLT3, NPM1, CEBPA, IDH1 and IDH2 variants in acute myeloid leukemia

Genetic testing for FLT3 internal tandem duplication, or FLT3-ITD; FLT3 tyrosine kinase domain, or FLT3-TKD; NPM1; CEBPA; IDH1 and IDH2 variants may be considered established in cytogenetically normal acute myeloid leukemia (if testing for all variants, panel testing [code *81450] may be appropriate).

Genetic testing for FLT3-ITD, FLT3-TKD, NPM1, CEBPA, IDH1, and IDH2 variants is considered experimental in all other situations.

Genetic testing for FLT3, NPM1 and CEBPA variants to detect minimal residual disease is considered experimental.

Policy updates are effective Sept. 1, 2019.

Payment policy

• Modifiers 26 and TC don’t apply.
• It isn’t payable in an office location or ASF.
• It’s payable to an M.D., D.O. and independent laboratory.

Inclusions:

Genetic testing for cytogenetically normal acute myeloid leukemia is intended to guide management decisions in patients who would receive treatment other than low-dose chemotherapy or best supportive care.

Genetic testing for IDH1 and IDH2 variants is intended for use as diagnostic and prognostic value in hematologic disorders, such as acute myeloid leukemia.