News
MEDICAL BILLING AND CODING UPDATES
Date: 06/03/24
This is to announcement is to notify you of prior authorization rule updates that will go into effectfor all lines of business and all products effective 7/01/2024.
The following new CPT Proprietary Laboratory Analyses (PLA) codes and CPT Category IIIcodes will require prior auth, unless determined to be a non-covered service, upon their effectivedate of 7/1/2024. For other established codes, please use the Pre-Auth Check Tools on ourwebsite to confirm if the code(s) requires prior authorization. Prior authorization requirementsvary based on the line of business, so please select the applicable Pre-Auth Check Tool by the line of business.
| CODE | DESCRIPTION |
|---|---|
| 0020M | ONC CNS ALYS 30000 DNA METHYLATION LOCI TUM TISS |
| 0450U | ONC MM LC-MS/MS MONOCLONAL P-PRTN SEQ ALYS SERUM |
| 0451U | ONC MM LC-MS/MS PEPTIDE ION QUANTIFICATION SERUM |
| 0452U | ONC BLADDER MTHYL PENK DNA DETCJ LTE-QMSP URINE |
| 0453U | ONC CLRCT CA CFDNA MTHYLTN BSD QUAN PCR ASY PLSM |
| 0454U | RARE DS ID VRTJ INVRJ INSJ TLCJ OPT GENOME MAPG |
| 0456U | AI RA NGS GEN XPRSN 19 GEN WHL BLD ALYS ANTI-CCP |
| 0457U | PFAS 9 PFAS COMPOUNDS LC-MS/MS PLASMA/SERUM QUAN |
| 0458U | ONC BREAST CA S100 A8&A9 ELISA TEAR FLUID ALG |
| 0459U | ABETA42 & TTAU ECLIA CEREBRAL SPINAL FLUID RATIO |
| 0460U | ONC WHL BLD/BUCCAL DNA SNP GNOTYP RT-PCR 24 GENE |
| 0461U | ONC RX-GENOMIC ALYS SNP GNOTYP RT-PCR 24 GENES |
| 0462U | MELATONIN LVL TEST SLEEP STUDY 7/9 SAMPLE ELISA |
| 0463U | ONC CERVIX MRNA GENXPRSN 14 BMRK E6&E7 HPV NASBA |
| 0465U | ONC UROTHELIAL CARC DNA QMSP 2 GENES ALG ALYS |
| 0466U | CRD CAD DNA GWAS 564856 SNP TRGT VARIANT GNOTYP |
| 0467U | ONC BLDR DNA NGS 60 GEN&WHL GENOME ANEUP UR ALG |
| 0468U | HEP NASH MIR-34A-5P A2M YKL40 HBA1C SRM&WHL BLD |
| 0469U | RARE DS WHL GENOM SEQ ALYS CHRMOML ABNR FTL SAMP |
| 0470U | ONC OROP DETCJ MRD NGS QUAN EVAL 8DNA CFHPV16&18 |
| 0472U | CA VI PSP&SP1 ANTB ELISA SEMIQL BLD SJOGREN SYND |
| 0473U | ONC SOLID TUMOR NGS DNA FFPE TISS BLD/SLV 648GEN |
| 0474U | HERED PAN CA GSAP 88 GENES 20DUP/DEL NGS BLD/SLV |
| 0475U | HERED PRST8 CA-RLTD DO GSAP NGS CGH EVAL 23 GENE |
| 0867T | TPLA B9 PROSTATIC HYPERPLASIA PRST8 VOL>=50 ML |
| 0868T | HIGH-RESOLUTION GASTRIC ELECTROPHYSIOLOGY MAPG |
| 0869T | NJX B1 SUB MATRL B1&/SFT TISSUE HW FIXJ AGMNTJ |
| 0870T | IMPLANTATION SUBQ PERITONEAL ASCITES PUMP SYS |
| 0871T | REPLACEMENT SUBCUTANEOUS PERITONEAL ASCITES PUMP |
| 0872T | RPLCMT INDWELLING BLADDER & PERITONEAL CATHETERS |
| 0873T | REVJ SUBQ IMPL PERITONEAL ASCITES PUMP SYSTEM |
| 0874T | REMOVAL PERITONEAL ASCITES PUMP SYSTEM |
| 0876T | DUPLEX SCAN HEMODIALYSIS FISTULA CPTR AIDED LMTD |
| 0877T | AUGMNT ALYS CH CT IMG DATA ILD WO CNCRNT CT EXAM |
| 0878T | AUGMNT ALYS CH CT IMG DATA ILD W/CNCRNT CT EXAM |
| 0879T | AUGMNT ALYS CH CT IMG DATA ILD DATA PREP&TRNSMS |
| 0880T | AUGMNT ALYS CH CT IMG DATA ILD PHYS/QHP I&R |
| 0881T | CRTX ORAL CAVITY TEMP REGULATED FLU COOLING SYS |
| 0884T | ESPHGSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
| 0885T | COLSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
| 0886T | SGMDSC FLX TRNSORL 1ST TNDSC DILAT RX BALO CATH |
| 0888T | HISTOTRIPSY MALIGNANT RENAL TISSUE W/IMG GDN |
| 0889T | PERSONALIZED TARGET DEVELOPMENT ARHFCMRIGTBS |
| 0890T | ARHFCMRIGTBS 1ST MOTOR THRESHOLD DETER 1ST TX D |
| 0891T | ARHFCMRIGTBS SUBSEQUENT TREATMENT DAY |
| 0892T | ARHFCMRIGTBS SBSQ MOTOR THRESHLD REDETER PR TX D |
| 0893T | N-INVAS ASSMT BLD OXY GAS XCHNG EFF&CARDRESP I&R |
| 0897T | N-INVAS AUGMNT ARRHYT ALYS QUAN CAR ARRHYT SIMUL |
| 0898T | NONINVASIVE PROSTATE CANCER ESTIMATION MAP |
| 0899T | N-INVAS DETER AQMBF AUGMNT ALG ALYS DATASET CMR |
| 0900T | N-INVAS EST AQMBF ASSITIVE ALG ALYS DATASET CMR |
For questions or additional information, please contact your Provider Engagement Administrator for your product.