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December 2015

Here are guidelines for genetic testing reimbursement

The following requirements are for laboratories seeking reimbursement for genetic testing from Blue Cross Blue Shield of Michigan:

  • All genetic testing must be performed according to the criteria in Blue Cross’ medical policy, provider manual or other Blue Cross provider communications.

  • Algorithms** driving secondary testing must be:
    • Approved by Blue Cross
    • Ordered by an attending physician
    • Supported by documentation in the medical record, or preauthorized by Blue Cross

  • Panels for genetic testing must be:
    • Approved by Blue Cross
    • Ordered by an attending physician
    • Supported by documentation in the medical record or preauthorized by Blue Cross

Note: For the purposes of this article, “approved by Blue Cross” refers to those algorithms** and panels listed on web-DENIS, in The Record or in any other Blue Cross publication.

**An algorithm is an evidence-based set of rules that allows clinicians and other medical professionals to make standardized decisions about testing, based on a given set of clinical circumstances and prior test results.

No portion of this publication may be copied without the express written permission of Blue Cross Blue Shield of Michigan, except that BCBSM participating health care providers may make copies for their personal use. In no event may any portion of this publication be copied or reprinted and used for commercial purposes by any party other than BCBSM.

*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2014 American Medical Association. All rights reserved.
Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and
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