Insurance Updates: August 18

By Policy and Advocacy Brief posted 08-18-2021 16:29

  

Insurance Updates:  August 18

Each week, the AUA publishes weekly updates on the latest insurance issues pertaining to urology. This week’s update includes the release of policies regarding systems pathology for predicting risk of recurrence in prostate cancer and treatment of benign prostatic hyperplasia.

BCBS Alabama

BCBS Alabama reviewed its Systems Pathology for Predicting Risk of Recurrence in Prostate Cancer (Commercial) Policy revising its position statement for systems pathology from “not medically necessary and investigational” to “investigational”.

Read the update.

BCBS Alabama reviewed its Treatment of Benign Prostatic Hyperplasia (Commercial) Policy updating its policy statement to remove “not medically necessary” with no change to policy intent.

Read the update.

Highmark BCBS Delaware

Highmark BCBS Delaware reviewed its Saturation Biopsy for Diagnosis and Staging of Prostate Cancer (Commercial) Policy adding HCPCS code G0416 to procedure codes.

Read the update.

Noridian

Noridian retired it Androgen Receptor Variant (AR-V7) Protein Test (MoIDX) (JE) (A57287) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Noridian retired its Androgen Receptor Variant (AR-V7) Protein Test (MoIDX) (JF) (A57291) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Noridian retired its Androgen Receptor Variant (AR-V7) Protein Test (MolDX) (JE) (L37746) Local Coverage Determination (LCD), effective July 28. The contractor states that the information in this policy has been incorporated within the MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells LCD.

Read the update.

Noridian retired its Androgen Receptor Variant (AR-V7) Protein Test (MolDX) (JF) (L37744) Local Coverage Determination (LCD), effective July 28. The contractor states that the information in this policy has been incorporated within the MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells LCD.

Read the update.

Noridian retired its Circulating Tumor Cell Marker Assays (MolDX) (JE) (A57815) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Noridian retired its Circulating Tumor Cell Marker Assays (MolDX) (JF) (A57816) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Noridian retired its Circulating Tumor Cell Marker Assays (MolDX) (L34066) Local Coverage Determination (LCD), effective July 28. The contractor states that the information in this policy has been incorporated within the MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells LCD.

Read the update.

Noridian retired its Circulating Tumor Cell Marker Assays (MolDX) (L35710) Local Coverage Determination (LCD), effective July 28. The contractor states that the information in this policy has been incorporated within the MolDX: Phenotypic Biomarker Detection from Circulating Tumor Cells LCD.

Read the update.

Noridian retired its OncoCee Circulating Tumor Cell Assay (MolDX) (A55593) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Noridian retired its OncoCee Circulating Tumor Cell Assay (MolDX) (A55598) Local Coverage Article (LCA), effective July 28. The contractor states that this article is being retired because the information in this article has been incorporated within the new article for “Phenotypic Biomarker Detection from Circulating Tumor Cells (MoIDX)”.

Read the update.

Palmetto

Palmetto reviewed its Molecular Diagnostic Tests (MolDX) (JJ, JM) (A56853) Local Coverage Article (LCA) adding the following code to HCPCS codes:

  • 0016M – Oncology (bladder), mRNA, microarray gene expression profiling of 209 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as molecular subtype (luminal, luminal infiltrated, basal, basal claudin-low, neuroendocrine-like)
  • 0250U – Oncology (solid organ neoplasm), targeted genomic sequence DNA analysis of 505 genes, interrogation for somatic alterations (SNVs [single nucleotide variant], small insertions and deletions, one amplification, and four translocations), microsatellite instability and tumor-mutation burden
Read the update.
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