Revised and reformatted list of proven and medically necessary indications:

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Applicable Codes Preventive Care Services

Revised coverage guidelines for Hepatitis C Virus Infection Screening:

  • Updated service description:
    • Removed June 2013 USPSTF “B” rating
    • Added March 2020 USPSTF “B” rating to indicate the USPSTF recommends screening for hepatitis C virus infection in adults aged 18 to 79 years o Removed list of applicable diagnosis codes
  • Updated preventive benefit instructions:

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Claims that are submitted for laboratory services subject to the Clinical Laboratory Improvement Amendments (CLIA) 1988 federal statute and regulations require additional information to be considered for payment.

A valid CLIA certificate identification number is required for reimbursement of clinical laboratory services reported on a CMS-1500 claim form (or its electronic equivalent) beginning October 1, 2020. The CLIA certificate identification number must be submitted in one of the following ways:

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Change policy title of Laboratory Policy No. 68. Adding CPT codes 0011U, 0116U, P2031 to this policy as investigational. Added oral fluid and hair drug testing to policy as investigational.

Effective Date: October 1, 2020

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A valid CLIA Certificate Identification number is required and must be included on each electronic claim billed for laboratory services, subject to CLIA legislation. You may not receive reimbursement for your electronic claims if the required certification number is missing.

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Preventive screenings are now shifting to the in-home setting through in-home screening kits, as payers like Humana innovate ways to carry on primary care and chronic disease prevention services remotely. The in-home preventive care packages are designed to support chronic disease prevention for members with diabetes or colon cancer. Both diabetes and cancer are among the top ten most expensive chronic diseases in the US.

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In response to the COVID-19 public health emergency, we are delaying implementation of the Laboratory Test Registry Protocol to 1/1/2021. To ensure compliance with these requirements, free standing and outpatient hospital lab providers should register their laboratory tests prior to December 1, 2020.

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Revision effective: 06-25-2020 Policy published 07-17-2020. Policy effective 06-25-2020.

§ Added PLA Code: 0223U.

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Published 07-09-2020. Effective 06-15-2020 Updated Description section

Updated Coding section-

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Coverage Rationale

• Updated list of examples of unproven and not medically necessary biochemical marker testing of maternal blood for maternal conditions; replaced “preeclampsia” with “e.g., PAPP-A testing for pre-eclampsia”

Applicable Codes

• Removed diagnosis codes O35.1XX1, O35.1XX2, O35.1XX3, O35.1XX4, O35.1XX5, and O35.1XX9

Supporting Information

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