Regence – Medicare Advantage Medical Policies – Changes Effective November 1, 2020

Genetic Testing

• Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Medicare #64)
  • Reformatted policy by consolidating similar tests when reasonable to reduce the size of the policy, as well as the number of hyperlinks to manage
  • Consolidated some columns to resize remaining columns with more detailed information
  • Added the FoundationOne Liquid CDx (from Foundation Medicine) to this policy with available Medicare references
• Genetic and Molecular Diagnostics – Single Gene or Variant Testing (Medicare #20)
  • Removed CPT 81504, 81507, 81519, 81538 and 0004M from this policy; these codes continue to require pre-authorization under our Genetic and Molecular Diagnostics – Next Generation Sequencing and Genetic Panel Testing (Medicare Genetic Testing #64) medical policy
  • No policy criteria changes

Laboratory

• COVID-19 Testing (Medicare #74)
  • Added travel to the list of testing purposes that are not eligible for coverage
• Multianalyte Assays with Algorithmic Analysis for the Evaluation and Monitoring of Patients with Chronic Liver Disease (Medicare #47)
  • Removed non-reimbursable service edits from CPT 0002M and 0003M; these codes will be considered always not medically necessary
  • Removed non-reimbursable service edits from CPT 0014M and 0166U; these codes will require pre-authorization
  • No policy criteria changes