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Upcoming coverage position changes for certain laboratory tests

July 29, 2016

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.


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