Medical Policy Updates

Notification of Policy Revisions Effective April 20, 2021 (Posted February 9, 2021)

Medical Policy Revision
ANA/ENA Testing AHS – G2022 "Notification" Reviewed by Avalon 4th Quarter CAB. Medical Director Review 1/2021. Description, Policy Guidelines, and References updates. When not covered section updated to include “The use of cell- bound activation products (e.g. AVISE Lupus) for the diagnosis of systemic lupus erythematosus (SLE) is considered investigational” and clarification of item six. Added code 81599. Policy noticed 2/9/2021 for effective date 4/20/2021.
Hormonal Testing in Adult Females AHS – G2161 "Notification" Annual review by Avalon 4th Quarter 2020 CAB. Title changed from Hormonal Testing in Females to Hormonal Testing in Adult Females. Items 2a-c and 6 added to Not Covered section. Note 1 moved to Note 2 and Note 1 added to not covered section. “This policy only addresses coverage of hormonal testing in adult females (age 18 years and older)” added to Description section. CPT codes 82397, 82681, and 86636 added. Description, Policy Guidelines, and References updated. Medical Director review 1/2021. Notification given 02/09/2021 for effective date 04/20/2021.
Testing for Autism Spectrum Disorder and Developmental Delay AHS – M2176 "Notification" New policy developed. BCBSNC will provide coverage for testing for autism spectrum disorder and developmental delay when it is determined to be medically necessary because the medical criteria and guidelines are met. Policy noticed 2/9/21, effective 4/20/21. Medical Director review 1/2021.