Carelon Genetic Testing Management Program CPT and HCPCS Codes
Defines CPT and HCPCS codes in-scope under the Carelon Genetic Testing Management Program for Blue Cross Blue Shield Massachusetts commercial and Medicare Advantage products and describes prior authorization request routes and exclusions. Affects providers submitting genetic testing for authorization and reimbursement under BCBSMA products.
CPT codes were added including 0583U, 0585U, 0586U, 0592U, 0597U, and 0204U effective 10/1/2025.
Policy revised to add that prior authorization is required for Medicare Advantage through Carelon, effective January 2025.
Multiple CPT codes were added across several prior update cycles (2021-2025) as documented in the policy history.
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