Highmark Commercial Medical Policy - Pennsylvania

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Medical Policy: L-182-004
Topic: Chromosome Analysis for Blood, Bone Marrow, and Solid Tumor Cancers
Section: Laboratory
Effective Date: November 13, 2017
Issue Date: November 13, 2017
Last Reviewed: June 2017

Chromosome abnormalities can include deletions, duplications, balanced or unbalanced rearrangements, and gain or loss of whole or partial chromosomes. These abnormalities can play a key role in the development, diagnosis, and monitoring cancer.

Chromosome analysis can be used to monitor disease progression and treatment response.

This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical circumstances may warrant individual consideration, based on review of applicable medical records.

Policy Position Coverage is subject to the specific terms of the member’s benefit plan.

Chromosome analysis on a bone marrow biopsy may be considered medically necessary and meets criteria without further review when performed in the evaluation of:

  • Leukemia; or
  • Lymphoma; or
  • Other hematological disorders.
Procedure Codes
88237, 88239

Professional Statements and Societal Positions

  • The National Comprehensive Care Network considers chromosome analysis of a bone marrow biopsy to be routine standard of care in the evaluation of acute myeloid leukemia (AML), chronic myelogenous leukemia (CML), multiple myeloma (MM), myelodysplastic syndromes (MDS), and Burkitt’s lymphoma (BL).
  • The American College of Medical Genetics (2010) provides technical laboratory guidelines for chromosome studies for acquired abnormalities:
    • "A patient with an acquired clonal chromosomal abnormality or one who is at high risk for developing such an abnormality may have multiple cytogenetic studies during the course of his or her disease."
    • "Bone marrow/blood: In most cases, bone marrow is the tissue of choice for analysis of suspected premalignant or malignant hematologic disorders."
    • "Lymph nodes: Common diagnoses include Hodgkin and non-Hodgkin lymphomas, including follicular, diffuse large B-cell, marginal zone, mantle cell, T-cell, and anaplastic large cell lymphoma."
    • "Solid tumors: Cytogenetic analysis of tumor tissue is performed to detect and characterize chromosomal abnormalities for purposes of diagnosis, prognosis, and patient management."

Place of Service: Outpatient

Chromosome analysis for blood, bone Marrow, and solid tumor cancers is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.

The policy position applies to all commercial lines of business

Denial Statements

Services that do not meet the criteria of this policy will not be considered medically necessary. A network provider cannot bill the member for the denied service unless: (a) the provider has given advance written notice, informing the member that the service may be deemed not medically necessary; (b) the member is provided with an estimate of the cost; and (c) the member agrees in writing to assume financial responsibility in advance of receiving the service. The signed agreement must be maintained in the provider’s records.


Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.

Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:
  • Provides free aids and services to people with disabilities to communicate effectively with us, such as:
    • Qualified sign language interpreters
    • Written information in other formats (large print, audio, accessible electronic formats, other formats)
  • Provides free language services to people whose primary language is not English, such as:
    • Qualified interpreters
    • Information written in other languages
If you need these services, contact the Civil Rights Coordinator.

If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Insurance or benefit/claims administration may be provided by Highmark, Highmark Choice Company, Highmark Coverage Advantage, Highmark Health Insurance Company, First Priority Life Insurance Company, First Priority Health, Highmark Benefits Group, Highmark Select Resources, Highmark Senior Solutions Company or Highmark Senior Health Company, all of which are independent licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.

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