Genetic testing, lab / pathology and pacemaker coding policies now available

We recently posted the following policies to our Provider Manual. Below are links and a high-level overview of each policy. Please see each policy for specific billing, coding and reimbursement details.

Genetic testing coding policy

• Background: This policy provides industry standard billing guidance to support correct billing. It includes the applicable medical policy which providers can reference for prior authorization requirements, whether the exact lab test name is required on the claim and documentation requirements that are standard for lab testing.
• Applies to: All plans
• Effective: N/A, providing transparency around existing requirements / expectations

Lab & pathology coding policy

• Description: This policy describes the reimbursement methodology for lab and lab-related services. It outlines billing guidelines for place of services, duplicates, multiple tests per day and diagnosis coding.
• Applies to: All plans
• Effective: N/A, providing transparency around existing requirements / expectations

Cardiology: Pacemakers coding policy

• Description: This policy provides industry standard coding information to support correct billing for single, dual and leadless pacemakers. It provides procedure definitions, shares specific modifiers and place of service codes and instructs providers on when a pre-service organization determination (PSOD) is needed for Medicare members.
• Applies to: Commercial and Medicare plans (for Medicaid, providers should reference the Medicaid Provider Manual)
• Effective: N/A, providing transparency around existing requirements / expectations