UHC - Delay Notification: Laboratory Services Policy, Professional

  • Jun 3, 2021

The effective date for the Laboratory Services policy update previously announced has been delayed. Effective with dates of service on or after July 1, 2021, UnitedHeathcare will update the Laboratory Services Policy, Professional. The policy lab panel bundling criteria will require all individual component lab codes to be present, as set forth in COT A lab panel code should only be reported...

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Blues Highlight Medical, Benefit Policy Changes

  • Jun 3, 2021

Basic benefit and medical policy - Updates Genetic testing for cystic fibrosis Genetic testing of CADASIL syndrome Breast cancer gene variants Testing for prognosis of colon cancer

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CIGNA - Policy Updates May 2021

  • Jun 3, 2021

Frequency Editing - (R34) The Centers for Medicare & Medicaid Services (CMS) has assigned medically unlikely edit (MUE) limits to laboratory services billed with Current Procedural Terminology (CPT®) codes 83921, 86318, 86332, 86353, and 87798. We will deny any units exceeding the MUE limits for these codes, effective for claims processed on or after May 16, 2021. Modifiers will not be...

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BCBS - Genetic Cancer Susceptibility Panels Using Next Generation Sequencing

  • Jun 3, 2021

Effective 05-14-2021 In the Policy section: Genetic Cancer Susceptibility Panels Using Next Generation Sequencing Replaced previous statement “Genetic cancer susceptibility panel testing using next generation sequencing are considered experimental / investigational.” with the following policy statement: “General genetic cancer susceptibility panel testing is considered experimental /...

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BCBS - Comprehensive Genomic Profiling for Selecting Targeted Cancer Therapies

  • Jun 3, 2021

This review focuses on "expanded" panels, which are defined as molecular panels that test a wide variety of genetic markers in cancers without regard for whether a specific targeted treatment has demonstrated benefit. This approach may result in treatment different from that usually selected for a patient based on the type and stage of cancer. Effective 05-11-2021 In Coding section: Added...

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Genetic and Protein Biomarkers for the Diagnosis and Cancer Risk Assessment of Prostate Cancer

  • Jun 3, 2021

On April 16, 2021 the description section was updated and the rationale section was updated in the coding section: Deleted CPT- 81479 Added CPT- 81542, 0047U, 0228U, and 86316 References Updated 05-07-2021 Description section updated In Policy section Added Item A.10

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Lawmakers Aim to Move 'Very Quickly' to Pass Bill Mandating Electronic Prior Authorization for MA Plans

  • Jun 3, 2021

Lawmakers behind a bill that would mandate Medicare Advantage plans to adopt electronic prior authorization are confident they can move the legislation quickly through the House. The legislation not only requires electronic prior authorization for MA plans, but also requires the Department of Health and Human Services to create a process for faster decisions on items and services that commonly...

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First Coast MAC - Allowance of QW Modifier on Codes u0002 and 87635

  • Jun 3, 2021

Effective for dates of service on and after March 2, 2020, CMS added the QW modifier (Clinical Laboratory Improvement Amendments Act [CLIA] waived tests) to procedure codes 87635 and U0002. However, the Common Working File (CWF) wasn’t updated to accommodate this request. A recent update has been made to the system. Resolution Claims impacted will be reprocessed for dates of service on and...

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