Reimbursement Policies

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Reimbursement Policies

03/14/2025

Starting June 13, 2025, EmblemHealth and ConnectiCare are introducing a new laboratory benefit management reimbursement policy to address therapeutic drug monitoring of 5-Fluorouracil. See: 

The following reimbursement policies have been updated. If the policy does not have a company name shown, the policy applies to both EmblemHealth and ConnectiCare. See their revision histories for effective dates and applicable changes:

  • Coronavirus Testing in the Outpatient Setting (LBM)
  • Diabetes Mellitus Testing (LBM)
  • Diagnosis of Idiopathic Environmental Intolerance (LBM)
  • Diagnostic Testing of Iron Homeostasis & Metabolism (LBM)
  • EmblemHealth’s Outpatient Diagnostic Imaging Self-Referral Payment Policy 
  • Immune Cell Function Assay (LBM)
  • Immunohistochemistry (LBM)
  • Pathogen Panel Testing (LBM)
  • Testing of Homocysteine Metabolism-Related Conditions (LBM)
  • Testosterone Testing (LBM)
  • Vitamin B12 & Methylmalonic Acid Testing (LBM)
  • Vitamin D Testing (LBM)

JP 68747 03/2025

Provider Update