Testing for Select Genitourinary Conditions

Date: 06/26/23

Ambetter From WellCare of New Jersey has made the following updates to CP.MP.97 Testing for Select Genitourinary Conditions:

Added 0330U and 0352U as not medically necessary for members over age 13 (new code for July 2022 with no utilization/cost data).

Changed matching requirements for ICD-10 B37.3 to apply to B37.31 and B37.32 which together now replace B37.3. There will be no savings change from this edit.

Changed CPT 87481 from not medically necessary in any circumstance to not medically necessary when paired with the following dx codes, and only applied to members age 13 years and over. Required the same dx code matching for new code 0353U (with no utilization/cost data): B37.31, B37.32, L29.2, L29.3, N39.0, N72, N76.0, N76.1, N76.2, N76.3, N76.81, N76.89, N77.1, N89.8, N89.9, N90.89, N90.9, N91.0 –N91.5, N92.0, N93.0, N93.8, N93.9, N94.3, N94.4 – N94.6, N94.89, N94.9, O09.00-O09.03, O09.10 –O09.13, O09.A0 – O09.A3, O09.211 – O09. 219.O09. 291 – O09. 299.O09.30 – O09.33.O09. 40 – O09.43, O09.511 – O09.519, O09.521 – O09. 529, O09.611 – O09.619, O09.621 – O09.629, O09.70 – O09.73, O09.811 – O09.819, O09.821 – O09.829, O09.891 – O09.899, O09.90 – O09.93, O23.511 – O23.93, Z00.00, Z00.8, Z01.419, Z11.3, Z11.51, Z22.330, Z23, Z30.011 – Z30.019, Z30.02, Z30.09, Z30.40 – Z30.9, Z32.00, Z33.1, Z34.00 – Z34.03, Z34.80 – Z34.83, Z34.90 – Z34.93, Z36.0 – Z36.5, Z36.81 –Z36.9, Z38.00 – Z38.01, Z38.30 – Z38.31, Z38.61 – Z38.69, Z39.0 – Z39.2, Z3A.00 – Z3A.49, Z72.51 – Z72.53, Z86.19, Z97.5

For more information, contact your Provider Relations representative. Thank you for being our partner in health.