Medical Policy Updates

Notification of Policy Revisions Effective April 13, 2010 (Posted January 05, 2010)

Medical Policy	Revision
Immune Cell Function Assay in Solid Organ Transplantation	Evidence Based Guideline converted to Corporate Medical Policy. "BCBSNC will not provide coverage for Immune Cell Function Assay in Solid Organ Transplantation because it is considered investigational. BCBSNC does not cover investigational services." Added new CPT code, 86352, to the "Billing/Coding" section. Changed the wording of "Providers may be submitting claims using CPT codes 86353 and/or 82397." to "Providers should not be submitting claims using CPT codes 86353 and/or 82397." Notice given 1/5/2010. Policy effective 4/13/2010.
Tumor Markers	ADDED "K. HUMAN EPIDIDYMIS PROTEIN 4 (HE4) MAY BE MEDICALLY NECESSARY FOR MONITORING PATIENTS WITH AN EXISTING DIAGNOSIS OF EPITHELIAL OVARIAN CANCER." TO THE "WHEN COVERED" SECTION. ADDED TO THE "WHEN NOT COVERED" SECTION, "C. HUMAN EPIDIDYMIS PROTEIN 4 (HE4) IS CONSIDERED INVESTIGATIONAL IN THE DIAGNOSIS OF PATIENTS PRESENTING WITH OVARIAN MASSES." ADDED NEW CPT CODE, 86305, TO THE "BILLING/CODING SECTION. NOTICE GIVEN 1/5/10. POLICY EFFECTIVE 4/13/10.

Medical Policy

Revision

Immune Cell Function Assay in Solid Organ Transplantation

Evidence Based Guideline converted to Corporate Medical Policy. "BCBSNC will not provide coverage for Immune Cell Function Assay in Solid Organ Transplantation because it is considered investigational. BCBSNC does not cover investigational services." Added new CPT code, 86352, to the "Billing/Coding" section. Changed the wording of "Providers may be submitting claims using CPT codes 86353 and/or 82397." to "Providers should not be submitting claims using CPT codes 86353 and/or 82397." Notice given 1/5/2010. Policy effective 4/13/2010.

Tumor Markers

ADDED "K. HUMAN EPIDIDYMIS PROTEIN 4 (HE4) MAY BE MEDICALLY NECESSARY FOR MONITORING PATIENTS WITH AN EXISTING DIAGNOSIS OF EPITHELIAL OVARIAN CANCER." TO THE "WHEN COVERED" SECTION. ADDED TO THE "WHEN NOT COVERED" SECTION, "C. HUMAN EPIDIDYMIS PROTEIN 4 (HE4) IS CONSIDERED INVESTIGATIONAL IN THE DIAGNOSIS OF PATIENTS PRESENTING WITH OVARIAN MASSES." ADDED NEW CPT CODE, 86305, TO THE "BILLING/CODING SECTION. NOTICE GIVEN 1/5/10. POLICY EFFECTIVE 4/13/10.