BILLING NEWS

LABORATORY MANAGEMENT PROGRAM CHANGES TO OCCUR ON JUNE 30, 2017, AND JULY 31, 2017

eviCore manages molecular and genomic testing within the Laboratory Management Program to ensure that the genetic lab services provided to Highmark's members support clinically appropriate care and are medically necessary, in accordance with their benefit policy. Certain changes will take effect for the Laboratory Management Program on June 30, 2017, and July 31, 2017. On June 30,2017 eviCore is updating the Laboratory Management Program by adding Proprietary Laboratory Analyses (PLA) codes to the program. PLA codes, created by the AMA, are alphanumeric CPT® codes that are a new addition to the CPT code set. PLA codes were created for labs or manufacturers that want to more specifically identify their test. The AMA will develop PLA codes on a quarterly basis. The following PLA procedure codes will be subject to prior authorization or claims review, as part of the Laboratory Management Program; 0001U, 0004U and 0005U. eviCore will be revising  Laboratory Management Clinical Guidelines, effective July 31, 2017. Please review the Executive Summary for an explanation of eviCore's revisions.


INDUSTRY NEWS TAGS: Highmark BCBS Pennsylvania, Highmark BCBS Delaware, Highmark BCBS West Virginia


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