BILLING NEWS

Blues highlight medical, benefit policy changes for Jun. 2014

Blue Cross Blue Shield of Michigan has updated its billing guidelines. Newly approved procedures will appear under the New Payable Procedures heading. Procedures for which they have changed a billing guideline or added a new payable group will appear under Updates to Payable Procedures. Procedures for which they are clarifying their guidelines will appear under Policy Clarifications. New procedures that are not covered will appear under Experimental Procedure.

NEW PAYABLE PROCEDURES


Established
81240, 81241
Experimental
81291

Basic Benefit and Medical Policy
Medical Policy has determined that genetic testing for factor V Leiden mutations and prothrombin gene mutations for inherited thrombophilia has been established in select patient populations who meet clinical criteria. This testing may be a useful diagnostic option when indicated.
Genetic testing for mutations in the MTHFR gene is considered experimental. There is limited published evidence on the utility of testing for MTHFR mutations for inherited thrombophilia. This policy is effective Jan. 1, 2014.

 

UPDATES TO PAYABLE PROCEDURES


0005M, 81599

Basic Benefit and Medical Policy
Nucleic acid sequencing-based testing of maternal plasma for trisomy 21 may be considered established in women with high-risk singleton pregnancies undergoing screening for trisomy 21. Karyotyping would be necessary to exclude the possibility of a false positive nucleic acid sequencing-based test. Before testing, women should be counseled about the risk of a false positive test.
Nucleic acid sequencing-based testing of maternal plasma for trisomy 21 in women who do not meet the above criteria is considered experimental.

83861

Basic Benefit and Medical Policy
Tear osmolarity testing may be considered established as indicated for the diagnosis and monitoring of Dry Eye Syndrome if slit lamp, as well as two other tests, fail to establish the suspected diagnosis of dry eye syndrome.

POLICY CLARIFICATIONS

Established
82172, 86141
Experimental
82610, 83695, 83701, 83704, 83880

Basic Benefit and Medical Policy
The safety and effectiveness of measuring apolipoprotein B have been established. It may be a useful diagnostic option when indicated for individuals at intermediate or high- risk for a cardiovascular event.
The safety and effectiveness of high sensitivity C-reactive protein measurement have been established. It may be a useful diagnostic option when indicated for individuals at intermediate-risk for a cardiovascular event.
The peer-reviewed medical literature has not demonstrated the clinical utility of laboratory testing of other novel biomarkers to assess cardiovascular risk, including, but not limited to apolipoprotein A-I, apolipoprotein E, LDL subclass, HDL subclass and lipoprotein[a]). Therefore, these services are considered experimental.
This policy is effective July 1, 2014.

EXPERIMENTAL PROCEDURES


83987, 95012

Basic Benefit and Medical Policy
The clinical utility of exhaled nitric oxide and exhaled breath condensate in the diagnosis and management of pulmonary disease and respiratory manifestations of underlying clinical conditions has not been demonstrated. In addition, there is insufficient evidence that the use of these tests improves health outcomes; therefore, these tests are considered experimental.
This policy is effective July 1, 2014.


SOURCE: Source
INDUSTRY NEWS TAGS: BCBS Michigan


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