Multitarget genetic testing procedure code *81443 became payable Aug. 1, 2021

Blue Cross Blue Shield of Michigan approved multitarget genetic testing procedure code *81443. The code is payable for patients seeking the following medical care:

• Testing for carrier status for severe, lethal or developmentally impactful genetic diseases and disorders
• Patients seeking evaluation or clinical interventions related to infertility
• Patients receiving prenatal services with encounters for routine prenatal care or non-procreative and procreative counseling where the number of targets tested is fifteen or above

For the above services, CPT code *81443 should be billed as opposed to individual, incremental gene testing codes. This change is effective Aug. 1, 2021.

Note: Blue Cross doesn’t provide separate reimbursement for individual gene codes when the gene tests performed can be collectively represented by a single CPT multitarget molecular genetic testing code.

Lab codes
Proprietary laboratory panel tests may be represented by proprietary laboratory analyses codes. Most of these panels consist of a combination of mutations found to be clinically useful as well as many mutations of uncertain or unknown clinical utility. Some of these proprietary tests are not covered by Blue Cross and coverage should not be assumed unless there is a specific Blue Cross medical policy identifying the test as established and therefore reimbursable.

When a selection of individual gene tests (15 or more) that may be included in a large proprietary lab panel are conducted, *81443 should be used. If both a multitarget CPT code (*81443) and the individual gene codes that may be included in a panel are billed — a process called unbundling — only the CPT multitarget code will be reimbursed.

Blue Cross uses data analytics to identify improper and unbundled claims. Keep in mind that unbundling claims to obtain payment or increased payment is a crime.