On October 1, 2020, Blue Cross and Blue Shield of Minnesota (Blue Cross) implemented a new initiative to ensure genetic testing laboratories are coding and submitting charges accurately and efficiently.
Summary
As increases in genetic and molecular testing continue, Blue Cross is committed to improving the sustainability of care by ensuring high-quality, appropriate care is delivered at a fair price.
In accordance with the new Blue Cross Reimbursement Policy for Genetic and Molecular Test Coding, all providers billing for genetic and molecular testing services are required to adhere to the coding recommendations from Concert Genetics, our industry-leading genetic testing technology partner. Billing integrity requirements in the reimbursement policy are administered on a post-payment review basis by Concert Genetics.
This policy applies to Commercial (effective 10/1/2020) and Medicaid (effective 6/1/2021) lines of business for the following tests:
- Molecular Pathology
- Genomic Sequencing Procedures and Other Molecular Multianalyte Assays
- Multianalyte Assays with Algorithmic Analyses
Concert Genetics provider portal
Please visit the Concert Genetics site to:
- Register with Concert Genetics and implement self-reporting quality metrics
- Verify accuracy of test catalog and review coding recommendations and fee schedule
- Utilize Concert Genetics’ recommended codes when billing for genetic and molecular tests
More information
Provider bulletin
A provider bulletin outlining this change was posted on July 1, 2020.
See provider bulletin on genetic/molecular lab test coding reimbursement policy (PDF)
Reimbursement policy
This is not a change in medical policy or member benefits, but a change in reimbursement policy. Reimbursement policies are updated on an ongoing basis and used by Blue Cross to define if and how certain claims will be paid for various health care services.
Beginning with October 1, 2020, dates of service, claims are being reviewed by Concert Genetics on a post-payment basis. Claims that are identified as being billed incorrectly will be denied and recouped by Blue Cross. Providers are encouraged to resubmit these services with the correct CPT signature to be considered for reimbursement.
See Genetic/molecular test coding reimbursement policy (PDF)