Alzheimer's Disease Tests (CPB 0349, reviewed 2026-08-04)

By 2026-08-04, the billing team must: (1) Update claim submission rules in billing software to require documentation of medical necessity for all covered CPT codes (0358U, 0445U, 0459U, 62270, 70551-70553, 81401, 81405, 81406, 82542, 83520) with specific criteria met (e.g., CSF biomarker detection for lumbar puncture, active therapy with Aduhelm/Leqembi/Kisunla for brain MRI, age <50 for genetic testing, consideration for monoclonal antibody therapy for ApoE4). (2) Create internal denial rules for all experimental/investigational codes listed in the policy (0206U, 82233, 82234 for plasma beta-amyloid, 84393 and 84394 for plasma tau, and all other non-covered tests) to auto-deny or route for clinical review before submission. (3) Notify providers and update encounter documentation templates to clarify which tests require prior authorization and which documentation elements are mandatory. (4) Train billing staff on the distinction between CSF-based tests (covered) vs. plasma-based biomarkers (not covered per policy). Failure to implement these rules will result in claim denials and payment reversals. Note the long effective date (August 2026) allows adequate transition time, but policy must be operationalized by that date.