Insurance Updates: July 27

By Policy and Advocacy Brief posted 07-27-2022 14:52

  

Insurance Updates:  July 27

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 gene expression profiling for bladder cancer and once in a lifetime procedures.

BCBS Arkansas

BCBS Arkansas issued its new Pluvicto Policy stating Pluvicto may be considered medically necessary when criteria are met.

Read the update.

BCBS Georgia

BCBS Georgia reviewed its Gene Expression Profiling for Bladder Cancer Policy revising the code descriptor for CPT code 0016M.

Read the update.

BCBS Georgia reviewed its Gene Mutation Testing for Solid Tumor Cancer Susceptibility and Management (Commercial) Policy revising the code descriptor for CPT code 0229U.

Read the update.

BCBS North Carolina

BCBS North Carolina reviewed its Once in a Lifetime (Commercial) Reimbursement & Billing Document stating “When a “Once in a Lifetime” procedure is reported, subsequent services specific to that removed body part or organ will not be reimbursable.”

Read the update.

BlueChoice HealthPlan of South Carolina

BlueChoice HealthPlan of South Carolina reviewed its Infertility and HCG Agents Policy adding gender dysphoria as an approved indication for agents for fertility preservation, along with associated criteria.

Read the update.

Palmetto

Palmetto retired its ConfirmMDx Epigenetic Molecular Assay (MolDX) (JJ, JM) (A56955) Local Coverage Article (LCA), effective July 3. This article is being retired because the information in this article has been incorporated within “Billing and Coding: MolDX Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer” (A58700) (L38985).

Read the update. (JJ, JM) (A56955)

Read the update. (JJ, JM) (L35632)

Palmetto issued a new version of its Lab-Developed Tests for Inherited Cancer Syndromes in Patients with Cancer (MolDX) (JJ, JM) (A58652) Local Coverage Article (LCA) with the following changes:

  • Under CPT/HCPCS Codes group 1: codes added 81322, 81403, 81404, 81405, and 81406, and deleted 81321.
  • Under CPT/HCPCS Codes group 2: codes added 81162, 81163, 81164, 81165, 81166, 81167, 81201, 81203, 81212, 81216, 81292, 81294, 81295, 81297, 81298, 81300, 81307, 81317, 81319, 81321, 81323, and 81351.
  • Under CPT/HCPCS Codes group 2: paragraph added verbiage “These code(s) are non-covered”.

Read the update.

Palmetto retired its Progensa PCA3 Assay (A53107) Local Coverage Article (LCA), effective July 3. This article is being retired because the information in this article has been incorporated within “Billing and Coding: MolDX: Molecular Biomarkers to Risk-Stratify Patients at Increased Risk for Prostate Cancer” (A58700).

Read the update.

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