Biomarker Testing in Risk Assessment and Management of Cardiovascular Disease

Effective December 1, 2024, the following two policies will be combined into one policy with the new policy title, identified in the header, above: 

• Novel Biomarkers in Risk Assessment and Management of Cardiovascular Disease (title change)
• Measurement of Lipoprotein-Associated Phospholipase A2 in the Assessment of Cardiovascular Risk (will be archived)

Also, effective December 1, 2024, CPT code 82610 will change from not covered for Medicare Advantage plans and not medically necessary for commercial products to medically necessary when filed with a covered ICD-10 code for both Medicare Advantage plans and commercial products. There will be no other changes in coverage for other tests included in this policy. For additional details related to this policy, please click here.  

Retinal Telescreening for Diabetic Retinopathy

Effective August 7, 2024, clarified that the correct claims processing instructions apply to both Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.

Vitamin D Testing

Effective December 1, 2024, additional ICD-10 codes for Crohn’s Disease and Ulcerative Colitis will be added to the list of covered ICD-10 codes for CPT code 82306 for both Medicare Advantage plans and commercial products. For additional details related to this policy, please click here.  

Interventions for Progressive Scoliosis 

Effective December 1, 2024, for both Medicare Advantage plans and commercial products, CPTs 0656T and 0657T will be removed from the 2024 New Technologies and Miscellaneous Services Medical Policy and will be added to the Interventions for Progressive Scoliosis Medical Policy effective starting December 1, 2024. For Medicare Advantage plans, CPTs 0656T and 0657T will change from requiring prior authorization to being not covered based on the Interventions for Progressive Scoliosis Medical Policy effective December 1, 2024. For commercial products, CPTs 0656T and 0657T will continue to be not medically necessary based on the Interventions for Progressive Scoliosis Medical Policy. For additional details related to this policy, please click here.

Next Generation Sequencing for Solid Tumors

Effective December 1, 2024, for both Medicare Advantage plans and commercial products, CPTs 0391U and 0334U will be added to the Next Generation Sequencing for Solid Tumors Medical Policy. CPTs 0391U and 0334U will change from being not medically necessary for commercial products to requiring prior authorization and will be reviewed based on the criteria in the Next Generation Sequencing for Solid Tumors Medical Policy. CPTs 0391U and 0334U will continue to require prior authorization for Medicare Advantage plans and will utilize the criteria in the Next Generation Sequencing for Solid Tumors Medical Policy. For additional details related to this policy, please click here.