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January 2013 Medical Policy Changes: Investigational Procedures

Release Date: November 5, 2012

Update: December 5, 2012

In order to be consistent with national coverage guidelines, Blue Cross and Blue Shield of North Carolina (BCBSNC) will consider urinary tumor markers for bladder cancer and certain cardiovascular disease risks tests as investigational effective January 1, 2013.  Our medical policies were updated as of October 1, 2012, to reflect these upcoming changes.

Urinary Tumor Markers for Bladder Cancer

BCBSNC will not be implementing the previously proposed changes to the Urinary Tumor Markers for Bladder Cancer medical policy on January 1, 2013, as previously advised on November 5, 2012.  We will advise you if a decision is made to proceed with these proposed changes at a later date.

Cardiovascular Disease Risk Tests 

The following CPT codes will be considered investigational beginning January 1, 2013:

  • 82172, 82664, 82610, 82726, 83695, and 83700
  • CPT code 85384 will result in the claim suspending for review, as this code may be used for other medically necessary clinical indication.

For more details, please refer to the Cardiovascular Disease Risk Tests BCBSNC corporate medical policy or to these related FAQs.

If you have any questions, please contact the Provider Blue LineSMat 1.800.214.4844.