Immunohistochemistry and Ancillary Pathology Testing Reimbursement
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This document governs reimbursement policy for immunohistochemistry and related ancillary pathology testing for Blue Cross Blue Shield - Tennessee members; it outlines evidence references and that the policy was adopted effective 7/1/2023.
No material clinical or coverage changes in this revision.
Coverage Criteria and Policy Adoption
References and policy adoption note
This section lists the scientific references and notes the policy adoption effective date; it does not contain itemized coverage criteria.
ALL of the following
- Policy references include peer-reviewed articles, clinical guideline updates, and diagnostic methodology texts relevant to immunohistochemistry and ancillary pathology testing (see citations).
- Key cited sources: Shah et al. (2012) analysis of immunohistochemical stain usage; Tuffaha et al. (2018) Immunohistochemistry in Tumor Diagnostics; multiple ASCO/CAP guidance updates on HER2 testing (Wolff et al. 2013, Wolff et al. 2018); Yamamoto et al. (2019) on pan-Trk IHC; Yamauchi & Hayes (2018) UptoDate review on HER2 and therapy response.
- Effective date: 7/1/2023 — policy adopted following Avalon recommendation.
Referenced Diagnostic Guideline Sources and Coding Notes
| No codes listed |
Reimbursement References and Provider Guidance
Reimbursement references and guidance — no specific PA or billing mandates
This reimbursement section provides references and guidance on immunohistochemical (IHC) stain usage and tumor diagnostic testing; there are no specific prior authorization, denial risk, or step therapy requirements stated in this section.
- Lists key clinical and guideline references informing reimbursement for IHC and tumor diagnostics (e.g., ASCO/CAP HER2 testing guidelines and diagnostic IHC references).
- No provider billing instructions, specific documentation checklists, or prior authorization steps are specified in these listed references or this policy excerpt.
Evidence and Definitions
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