Added codes
Effective March 1, 2018
Autografts and Allografts in the Treatment of Focal Articular Cartilage Lesions, 7.01.78
Now requires medical necessity review, now requires prior authorization
27415 - Osteochondral allograft, knee, open
27416 - Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])
28446 - Open osteochondral autograft, talus (includes obtaining graft[s])
29866 - Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])
Revised codes
Effective March 1, 2018
Noninvasive Prenatal Screening for Fetal Aneuploidies and Microdeletions Using Cell-Free Fetal DNA, 4.01.21
Now reviewed for investigative, no longer reviewed for medical necessity
81422 - Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood
Removed codes
Removed as of January 1, 2018
Assays of Genetic Expression in Tumor Tissue as a Technique to Determine Prognosis in Patients with Breast Cancer, 12.04.36
No longer reviewed for medical necessity, no longer requires prior authorization
0008M - Oncology (breast), mRNA analysis of 58 genes using hybrid capture, on formalin-fixed paraffin-embedded (FFPE) tissue, prognostic algorithm reported as a risk score
Genetic Testing for Mental health Conditions 12.04.515
No longer reviewed for investigative, no longer requires prior authorization
0015U - Drug metabolism (adverse drug reactions), DNA, 22 drug metabolism and transporter genes, real-time PCR, blood or buccal swab, genotype and metabolizer status for therapeutic decision support