Carelon Genetic Testing Management Program CPT and HCPCS Codes
Lists CPT/HCPCS codes in-scope under the Carelon Genetic Testing Management Program for BCBSMA commercial and Medicare Advantage products and describes prior authorization request routes and exclusions; affects providers billing Blue Cross Blue Shield of Massachusetts plans.
Policy revised to add that prior authorization is required for Medicare Advantage through Carelon, effective 1/1/2025.
Multiple CPT codes (0575U, 0576U, 0578U, 0582U, 0583U, 0585U, 0586U, 0592U, 0597U, 0204U) were added effective 10/1/2025.
CPT codes 81354; 81524; 0605U; 0611U; 0612U; 0613U were added effective 1/1/2026.
CPT codes 0628U and 0630U were added effective 4/1/2026.
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