Serum Testing for Hepatic Fibrosis in the Evaluation and Monitoring of Chronic Liver Disease - Lab Benefit Program (LBM)
Defines coverage and limitations for serum-based fibrosis biomarkers and panels (Lab Benefit Program) for evaluation and monitoring of chronic liver disease across EmblemHealth products; applies per-member benefit design and federal/state rules referenced in the policy.
Coverage criteria reorganized: HBV and HCV allowed tests (all 4) broken out from MASLD, MASH, and alcoholic hepatitis; former Coverage Criteria 2, 3, and 4 renumbered to 3, 4, and 5 and edited for clarity.
Addition of 'once every 6 months' frequency to Coverage Criterion 1 for specified conditions.
Removal of CPT/HCPCS codes 88341, 88342, 0002M, 0003M, 0166U, 0344U & 0468U from Applicable CPT/HCPCS Procedure Codes.
Added CPT code 0468U to Applicable CPT/HCPCS Procedure Codes in a previous revision (noting policy history).
Lab Benefit Program (LBM) expanded to include EmblemHealth HMO/PPO (Non-City) Commercial, Medicare and Medicaid plans effective 10/1/2024.
Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.