Effective October 1, 2016, our coverage position on the
laboratory tests outlined below will be considered
experimental/investigational.
Fecal calprotectin
Effective October 1, 2016, procedure code 83993: Fecal
calprotectin will be considered experimental/investigational for all
commercial and Medicare Advantage members.
Fecal calprotectin is a calcium- and zinc-binding protein that is a
potential marker of intestinal inflammation. Fecal
calprotectin testing is proposed as a noninvasive test to diagnose inflammatory
bowel disease (IBD). Other proposed
uses are to evaluate response to treatment for patients with IBD and as a
marker of relapse. Peer-reviewed evidence
does not unequivocally support the clinical usefulness of this testing for
management of any patient populations.
Nontraditional lipid biomarkers
Effective October 1, 2016, the following procedure codes will be considered
experimental/investigational for all
commercial members:
- procedure code 83695: Lipoprotein (a);
- procedure code 83700: Lipoprotein, blood; electrophoretic
separation and quantitation;
- procedure code 83701: Lipoprotein, blood; high-resolution
fractionation and quantitation of lipoproteins including
lipoprotein subclasses when performed (e.g., electrophoresis,
ultracentrifugation).
Low-density lipoproteins (LDLs) have been identified as the major
atherogenic lipoproteins and have long been
identified by the National Cholesterol Education Project (NCEP) as the primary
target of cholesterol-lowering
therapy. Numerous nontraditional lipid and non-lipid biomarkers have been
proposed as potential risk markers for
cardiovascular disease. There is a lack of consensus among professional
guidelines, and the quality of peer-reviewed
evidence is insufficient to determine the effects of these nontraditional lipid
and non-lipid biomarkers on relevant
health outcomes, including any clinically important information beyond that of
traditional lipid measures, in the
intended patient populations.
Policy updates
The change in coverage position for these procedure codes is also
communicated in the following policy Notifications,
which were posted on July 1, 2016, and will become effective on October 1,
2016:
- Commercial: #12.01.01ah: Experimental/Investigational
Services
- Medicare Advantage: #MA00.005g:
Experimental/Investigational Services
To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to
Medical Policy Online. Then select either Commercial or Medicare
Advantage under Active Notifications.
If you have any questions about these changes, please contact your Network
Coordinator.