CommercialCoverageMedium impact
Inflammatory Markers of Coronary Artery Disease Risk 2.02.15
Excellus BlueCross BlueShield·Cardiology, Internal Medicine, Family Medicine·Lab Tests (pathology)
Effective date
Jul 17, 2025
We identified it
Jun 20, 2026
Summary
Excellus BlueCross BlueShield updated their policy on inflammatory markers for coronary artery disease risk assessment, effective July 17, 2025. High sensitivity C-reactive protein (hs-CRP) testing is only covered for patients at intermediate risk (10-20% over 10 years) without inflammatory conditions, while other inflammatory markers like Lp-PLA2 and MPO are considered investigational and not covered.
Action Required
By July 17, 2025: Billing team must update prior authorization requirements for hs-CRP testing to ensure patients meet intermediate risk criteria (10-20% cardiovascular risk over 10 years per Framingham scoring) and are free of inflammatory conditions like rheumatoid arthritis. Providers must document risk assessment and absence of inflammatory conditions. Stop billing for Lp-PLA2 and MPO inflammatory marker tests as they will be denied as investigational. Update encounter forms to include cardiovascular risk assessment documentation requirements.