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Effective February 1, 2010, Blue Cross & Blue Shield of Mississippi will implement new medical policies related to general health panels, thyroid stimulating hormones and bone mineral density studies. Please see below for details:
All medical policies referenced below can be found through a medical policy search.
General Health Panel
Effective February 1, 2010, Blue Cross & Blue Shield of Mississippi will no longer consider general health panels a medically necessary service. In most situations, there are rarely medically necessary indications to perform all three services at the same time. This is consistent with Medicare guidelines for general health panels. If there is a medical need to perform some of the labs within the panel, these labs should be performed individually and submitted accordingly. If all the lab components within the panel are performed, you must submit the components under the global panel code. If a general health panel is submitted on the claim, it will be denied as not medically necessary; therefore, network providers may not bill the patient for these denied charges. This applies to all claims, including Healthy You! claims.
Thyroid Stimulating Hormone
Effective February 1, 2010, thyroid function tests may be considered medically necessary as a medical benefit for patients who meet certain criteria as outlined in the Blue Cross & Blue Shield of Mississippi Thyroid Stimulating Hormone Medical Policy. Changes to Medical Policy will require that certain criteria must be met for frequent and follow up thyroid function testing. Additionally, there will be a limitation in the number of times thyroid function tests may be allowed per year in clinically stable patients.
Bone Mineral Density Studies
Effective February 1, 2010, bone mineral density studies may be considered medically necessary as a medical benefit for patients who meet certain risk criteria as outlined in the Blue Cross & Blue Shield of Mississippi Bone Mineral Density Studies Medical Policy. Changes to Medical Policy will require that certain risk criteria must be met for initial, repeat and serial bone mineral density measurements. Additionally, there will be a limitation on the frequency of repeat and serial bone mineral density measurements based on risk factors.
Bone density screenings will be covered under the Healthy You! Program once per lifetime for women 50 years and older. Please verify benefits prior to performing a bone density screening to ensure your patient has Healthy You! benefits.
Our data indicates that some network primary care providers and laboratories have been billing general health panels, thyroid testing procedures, bone mineral density studies and other non-covered wellness procedures as part of a Healthy You! visit.
Effective February 1, 2010, any services billed as wellness services outside of the Healthy You! Wellness Procedures Coding Guidelines specific to age and gender will be denied as not medically necessary wellness procedures. Healthy You! is a wellness benefit that provides an annual wellness visit with a network provider. The benefit includes only wellness services outlined within certain age and gender coding guidelines. Services provided outside of the Healthy You! Wellness Procedures Coding Guidelines will be denied as not medically necessary; therefore, network providers may not bill the patient for these denied charges. It is important that all services available as part of a Healthy You! visit, for the appropriate age and gender, be performed annually for your patients who have the Healthy You! benefit.
In rare circumstances when a service must be provided related to an illness during a Healthy You! exam, you must code this additional service with the appropriate illness diagnosis on the claim. Additionally, fully documented medical records are required to support the use of the illness diagnosis.
It is very important that you review the on-line medical policy located on this site to determine the impact to your clinic and/or to your contracted laboratories.