Updated Reimbursement Policies

EmblemHealth is adding one new Lab Benefit Management (LBM) Reimbursement Policy: 

• Prenatal Testing for Fetal Aneuploidy - Lab Benefit Program (LBM).

The following reimbursement policies have been updated. See revision histories for effective dates and applicable changes:

• Ambulatory Surgical Groupers.
• Bundled Services. 
• Daily Maximum Units. 
• Diagnosis of Idiopathic Environmental Intolerance – Lab Benefit Program (LBM). 
• Diagnostic Testing of Iron Homeostasis and Metabolism – Lab Benefit Program (LBM). 
• Immune Cell Function Assay – Lab Benefit Program (LBM). 
• Immunohistochemistry – Lab Benefit Program (LBM). 
• Laboratory/Venipuncture – Effective 1/1/2025.
• Nerve Fiber Density Testing – Lab Benefit Program (LBM). 
• No Cost/Reduced Cost Drugs, Implants & Devices.
• Radiopharmaceuticals and Contrast Media.
• Telehealth/Virtual Care Services.
• Testing of Homocysteine Metabolism-Related Conditions – Lab Benefit Program (LBM). 
• Testosterone – Lab Benefit Program (LBM). 
• Therapeutic Drug Monitoring for 5-Fluorouracil – Lab Benefit Program (LBM). 
• Urinary Tumor Markers for Bladder Cancer – Lab Benefit Program (LBM). 
• Vitamin B12 and Methylmalonic Acid Testing – Lab Benefit Program (LBM) .
• Vitamin D Testing – Lab Benefit Program (LBM).