CPT 81347 is referenced in 3 tracked payer policy changes from Blue Cross Blue Shield of Rhode Island, Indiana Medicaid (IHCP), and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 81347 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Multiple medical policy updates take effect July 1, 2025, affecting various testing services and prior authorization requirements. Key changes include biomarker testing moving from prior auth required to not covered for Medicare Advantage, phototherapy becoming covered for Medicare Advantage, and numerous genetic/molecular testing codes having prior authorization removed or coverage criteria changes.
The IHCP reviewed the Outpatient Fee Schedule, found discrepancies, and will reflect the changes in the next regular update to that schedule. Codes listed twice on previous versions will appear only once, codes missing from the schedule are covered in the outpatient setting and can be billed for dates of service on or after the date listed for each code, and other listed codes are noncovered and will be added to the schedule. Codes that have been nationally end dated will be removed from the schedule, and Current Dental Terminology (CDT) codes cannot be billed on institutional claims (UB-04 claim form or electronic equivalent).
Effective January 1, 2021, Immune Globulin Therapy criteria changed so that preventive IVIG use after hematopoietic cell transplantation, in chronic lymphocytic leukemia, lymphoma, multiple myeloma and solid organ transplant became investigational, and IVIG for humoral immunodeficiency states now requires an IgG level below 400 mg/dL with persistent or recurrent infections. Effective January 1, 2021, the Drugs for Weight Management policy was added for Contrave, Qsymia, Saxenda and Xenical for groups that cover weight loss drugs, and the Exception Request policy for Washington fully insured members was added. Coding updates made CPT 69705, 69706 and 55880, and HCPCS Q5122, J9316, J7352, J0638 and J1823 subject to medical necessity and prior authorization review, and made the listed AIM genetic testing codes subject to prior authorization starting January 1, 2021.
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