If you are a provider or a LAB that is ordering or offering the following tests for your Anthem BCBS of Virginia and its Affiliate Healthkeepers Inc. patients this blog post is for you! Effective date is 07/01/2022
These following NEW LAB guidelines impact all our products – with the exception of Anthem HealthKeepers Plus (Medicaid), Medicare Advantage, the Commonwealth Coordinated Care Plus (Anthem CCC Plus) plan, and the BlueCross and Blue Shield Service Benefit Plan (also called the Federal Employee Program® or
FEP®). Furthermore, the guidelines were among those recently approved at the Medical Policy and Technology Assessment Committee meeting held on February 17, 2022.
LAB.00043-Immune Biomarker Tests for Cancer -This new lab policy addresses the coverage for immune response algorithmic tests for oncologic disease management At least one test, Immunoscore® (Veracyte Inc.), which has been investigated for management of colon cancer, is commercially available. According to this policy Anthem BCBS of Virginia and its affiliate Healthkeepers Inc., consider oncologic immune biomarker tests are considered investigational and not medically necessary for all indications. CPT codes: 0261U
LAB.00044-Saliva-based Testing to Determine Drug-Metabolizer Status– this new lab policy addresses the coverage for saliva-based testing to determine drugmetabolizer status. Saliva-based testing to determine drug-metabolizer status is considered investigational and not medically necessary for all indications. The CPT code associated with this new coverage guideline is 84999.
LAB.00045-Selected Tests for the Evaluation and Management of Infertility– this NEW Lab policy addresses the coverage for selected tests that are part of the diagnostic work-up to determine the cause of infertility or manage infertility treatment. According to Anthem BCBS of Virginia and its affiliate the following tests or procedures are considered investigational and not medically necessary for diagnosing or managing infertility:
• Endometrial receptivity analysis;
• Sperm-capacitation test;
• Sperm deoxyribonucleic acid (DNA) fragmentation test;
• Sperm penetration assay; and
• Uterine natural killer (uNK) cells test.
The CPT codes associated with this new coverage guideline are 86357, 89329, 89330, 89398, 0253U, and 0255U.
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