As a result of coding updates in our claims system, claim edits for the policies and clinical guidelines listed below will be revised. This will result in the review of claims for certain diagnoses before processing occurs to determine whether the service meets medical necessity criteria. As a result, these coding updates may result in a not medically necessary and/or investigational determination.

 

Effective September 1, 2019, we will be implementing coding updates in the claims system for the following policies listed below which may result in investigational/not medically necessary determinations for certain services.

  • GENE.00001 - Genetic Testing for Cancer Susceptibility
  • GENE.00007 - Cardiac Ion Channel Genetic Testing
  • GENE.00003 - Genetic Testing and Biochemical Markers for the Diagnosis of Alzheimer's Disease
  • GENE.00017 - Genetic Testing for Diagnosis and Management of Hereditary Cardiomyopathies (including arrhythmogenic right ventricular dysplasia/cardiomyopathy)
  • GENE.00023 - Gene Expression Profiling of Melanomas



Featured In:
June 2019 Anthem Maine Provider Newsletter