CommercialCoverageMedium impact
Reimbursement Policies
EmblemHealth·Oncology, Pathology, Endocrinology +5 more·Provider News
Effective date
Jun 13, 2025
We identified it
Jun 27, 2026
Summary
EmblemHealth and ConnectiCare are introducing a new laboratory benefit management reimbursement policy effective June 13, 2025, specifically addressing therapeutic drug monitoring of 5-Fluorouracil. Additionally, 11 other laboratory and diagnostic imaging policies have been updated with revised reimbursement guidance. Billing teams must review revision histories for each affected policy to identify specific effective dates and applicable changes.
Action Required
By June 13, 2025: Billing team must access and review the complete revision histories for all 12 updated policies listed (Therapeutic Drug Monitoring of 5-Fluorouracil, Coronavirus Testing in the Outpatient Setting, Diabetes Mellitus Testing, Diagnosis of Idiopathic Environmental Intolerance, Diagnostic Testing of Iron Homeostasis & Metabolism, Outpatient Diagnostic Imaging Self-Referral Payment Policy, Immune Cell Function Assay, Immunohistochemistry, Pathogen Panel Testing, Testing of Homocysteine Metabolism-Related Conditions, Testosterone Testing, Vitamin B12 & Methylmalonic Acid Testing, and Vitamin D Testing) on the EmblemHealth and ConnectiCare websites. Identify specific billing code changes, prior authorization requirements, and coverage modifications from each policy's revision history. Update billing software, encounter forms, and clinical workflows accordingly. Document all changes by specialty area affected. Failure to implement changes by the effective date may result in claim denials or improper reimbursement.