Blues Highlight Medical, Benefit Policy Changes

  • Feb 10, 2020

Code BCBSM changes to: Basic Benefit and Medical Policy, Group Variations Payment Policy, Guidelines 81406 Basic benefit and medical policy Not covered: 81408 (used to report ATM variant), 81479 (used to report CHEK2 variant) Moderate penetrance variants associated with breast cancer in individuals at high risk The safety and effectiveness...

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CYP2C19 Gene Analysis Is a Medi-Cal Benefit and Updated Billing Requirements for SMN1 Gene Analysis

  • Feb 10, 2020

CYP2C19 Gene Analysis Is a Medi-Cal Benefit: Effective for dates of service on or after February 1, 2020, CPT code 81225 (CYP2C19 [cytochrome P450, family 2, subfamily C, polypeptide 19], gene analysis, common variants) is a Medi-Cal benefit. The frequency limit is once in a lifetime and one of the following ICD-10-CM diagnosis codes is required for reimbursement: I21.01 – I24.9. A Treatment...

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Researchers Identify Breast Cancer Target Genes Via Fine-Mapping of Disease Risk Regions

  • Feb 10, 2020

An international team of researchers has identified 191 likely breast cancer target genes in 150 disease risk regions using a fine-mapping technique that analyzes gene expression, chromatin interaction, and functional annotations. In a study published on Tuesday in Nature Genetics, the team noted that while GWAS studies have identified breast cancer risk variants in more than 150 genomic...

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New Surprise Billing Legislation and Rules Go Into Effect on January 1

  • Feb 10, 2020

The Texas Department of Insurance promulgated emergency rules to implement SB 1264 on December 18, 2019, which then went into effect simultaneously with SB 1264’s other provisions on January 1, 2020. The emergency rules added additional detail and requirements to SB 1264’s other requirements. One additional requirement is that an out-of-network provider cannot “balance bill” a patient unless the...

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Medical Policy and Clinical Guideline Updates - February 2020

  • Feb 10, 2020

*GENE.00052 Whole Genome Sequencing, Whole Exome Sequencing, Gene Panels, and Molecular Profiling - 5/1/2020 *CG-GENE-14 Gene Mutation Testing for Solid Tumor Cancer Susceptibility and Management - 2/5/2020 *CG-GENE-13 Genetic Testing for Inherited Diseases - 2/5/2020 *CG-GENE-20 Epidermal Growth Factor Receptor (EGFR) Testing - 2/5/2020 *CG-GENE-15 Genetic Testing for Lynch Syndrome,...

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Adjustment of Laboratory Services Claims Due to Retroactive Rate Updates

  • Feb 10, 2020

The Department of Health Care Services (DHCS) is implementing an additional phase of the Erroneous Payment Correction (EPC) related to reference number P33416. The upcoming phase, P33416G, adjust provider reimbursement rates for clinical laboratory services, effective retroactively for dates of service on or after July 1, 2015. The clinical laboratory rates were updated in accordance with...

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MolDx Finalizes Expanded Coverage for Liquid Biopsies

  • Feb 10, 2020

The policy stipulates that WPSIC will only cover the Guardant360 assay if the patient has a recurrent, relapsed, refractory, metastatic, or advanced solid tumor that didn't originate from the central nervous system. The Medicare contractor further noted that patients who have an NTRK mutation and meet all the indications in the US Food and Drug Administration-approved label for...

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US Senators Introduce Law to Enable WGS Testing on Children With Rare Diseases

  • Feb 10, 2020

US Senators Bob Menendez (D-New Jersey), Doug Jones (D-Alabama), Martha McSally (R-Arizona), and Susan Collins (R-Maine) have introduced legislation in the Senate intended to help children with rare diseases receive testing with whole-genome sequencing in hopes of finding a cause for their conditions. The legislation, called the Ending the Diagnostic Odyssey Act, would allow states to...

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